Some patients come to me because they feel very stressed at work. Usually, stress comes from a fear of making a mistake, or an overlapping fear of being scolded. Since everyone makes mistakes, no matter how important the job, and everyone is going to be scolded by a boss sooner or later, deserved or not, these people are under more stress than a colleague who is doing the same work, but who is not embarrassed by these ordinary failings. Sometimes these fears grow out of self-doubts that have developed during the course of growing up. These worried workers cannot afford to make a mistake because it would reveal how incompetent they really are. Or so they think.

There is a sub-group among these anxious workers who have compensated for their sense of inadequacy by trying their very hardest, no matter what they are asked to do. They tackle every task by giving it their best effort. One such person repeated to me the old saying, “If something is worth doing, it is worth doing well.”  Like many other old sayings, it is completely wrong. Someone trying his/her best all the time will soon become exhausted. And resentful of being asked to do too much. What every student, or employee, must learn is just how much effort should be committed to doing each of the various tasks that need to be accomplished.

These are my observations. Consider the percentages as approximations:  

  1. About ten percent of the jobs a worker or a student is required to do require the very best effort that can be brought to bear. (Maybe only eight or nine percent.) These tasks are so difficult, and/or so important, that they must be done as well as possible. Examples might include studying for a final examination, or presenting to an important client, or making a summation to a jury, or going on an audition. And so on. Creative endeavors usually fall into this category since they are otherwise unlikely to succeed.
  2. About forty-six percent of tasks have to be done correctly. Competently. The job has to be done properly, whether it is grinding out a homework assignment or making a sale to a client, or building something to specifications. It is the kind of performance an experienced worker does without requiring much initiative or originality.
  3. About thirty-seven percent of tasks do not have to be done correctly. They simply have to be done. The work has to go from the in-box to the out-box. Paper work often has this character. Other examples include moving the work from one location to another location, or speaking up occasionally in class, or simply showing up in class. Sitting in on a conference may not be doing anything useful, but may be required anyway.
  4. A certain percentage of what the job description entails does not have to be done at all. About seven to ten percent. Coming in exactly on time, for instance. A reading list may be required for a course, but is not really, truly, required. Sometimes attendance at a class is compulsory, but no one checks. Someone may be sent to a professional meeting with the expectation (not really) that that individual will be attending all of the workshops. But nobody does so.

It is folly for a worker or a student to put out a maximum effort without regard to which category of work is being performed. Someone who puts in his/her best all the time will feel under time pressures and will become resentful. Doing all of these things all of the time will accomplish no more than choosing sensibly which of those things require concentration and real effort.

I pointed out these distinctions to my granddaughter, Grace, when she was about sixteen. I was concerned that she was inclined to stay up too late doing her school work. Of course, she was a very good student; but I thought she was paying too high a price. Being a serious and sensible young woman, she asked me the critical question: “When I’m working, how do I know which category the work falls into?” The answer is, it is not always easy to know. Usually, making that decision properly depends on learning what the boss or the teacher wants, and what is really required to do a good job.

When I was in the army, I had to sign various documents all day long. The proper disposition of certain administrative actions required that I sign six copies. The work itself was straightforward. Very little judgment was required. It fell into the second category I listed above. Signing all six copies seemed to me to fall into the third or fourth category. One day I found out which. I neglected to sign a sixth copy. A week later the whole document was returned to me and had to be done all over. Obviously, six signatures were really required.

But, it was not clear that I had to do a good job of signing my name. In time, I experimented. I signed quicker and quicker. My signature looked like a series of round humps, something like a bunched up inch worm. That was sufficient for the army’s purposes. I kept simplifying my signature until it was reduced to its essence: a straight line. That was good too. The presence of the signature fell into category three, but the signature—as signature—fell into group four. No real signature was required.

It would have been an annoying waste of time for me to produce a good-looking (legible) signature. I had other things to do with my time. The army had a host of other pointless tasks I had to accomplish.

Of course, there is a whole diagnostic category of individuals who are likely to spend exorbitant amounts of time doing everything perfectly, if they can. Compulsive persons struggle to do things just right. For them, there is a single correct way of walking down the street, washing their hands, and straightening their shoes. Every other way is wrong.  Consequently, at work they cannot make any of the distinctions described above. Everything has to be done to the best of their ability. I knew a woman who spent five hours every day before work cleaning her bathroom.  The task of cleaning a bathroom, I would hold, belongs in category three and not one. Another religious woman spent hours each morning trying to get through a prayer correctly. Some accident of intonation or pronunciation made her start all over again. Praying, I think, falls into group three—and for some others into group four. Those who suffer from obsessive-compulsive disorder are under tremendous pressure at work because there are so many things that have to be done just right.

But there are others who keep running as fast as they can at work, doing everything as if everything “is worth doing well.” Some of these are medical students.

Medical students, at least in my day, were an unusual bunch of guys. (In my class there were five women out of a class of one hundred and ten.) In order to get into medical school, you did not have to be smart, but you had to be a very, very good student. Being a very, very good student meant (for most of them) working very, very hard. Even subjects which did not merit careful attention were examined assiduously and in detail. “Anything could be on a test.” Of course, those students who graduated at the top of the medical school class were very, very, very good students. Three out of the top four students in my class, for instance, were unrecognizable to me at graduation. Where were they the last four years?  Not in the Hall of Residence, where I lived. Not in the music room or the card rooms. Not in the library, where I had gone from time to time. They were hibernating somewhere, surrounded by books, I imagined.

They have done studies on what happens to people who graduate at the top of their medical school classes.  In subsequent years, they do not do well—even by academic standards. They are less likely to have taken their specialty boards then their classmates. The reason is obvious. They have so committed themselves to learning as much as they can, that they have divorced themselves from ordinary life. When they get to a place where no one is marking them, they flounder.

I had one odd experience with such a medical student during the summer after our freshman year. A number of us were offered jobs by Pfizer, the drug company. Their headquarters was in Brooklyn, which was convenient to most of us. They paid us one hundred dollars a week, which was four times the weekly salary I had made the previous summer. We were supposed to be contributing to their in-house journal,  Spectrum. However, after the first few weeks, it became obvious that our contributions were being ignored. Finally our supervisor explained why. The job was simply a good will offer by the drug company. After all, we were going to be doctors someday. We would be prescribing drugs.

For the rest of the summer, we came into work regularly (see group three above); but we did crossword puzzles or read books. But evidently not all of us.

One Friday afternoon in the middle of August I was standing on a subway platform waiting for a train back into Manhattan. Another student was standing there also. He was carrying a briefcase.

“What’s with the briefcase?” I asked.

“Some stuff I was working on.”

“Stuff for Pfizer? You know, they aren’t going to use anything we do. They told us that.”

“I know,” he said, a little sheepishly. “Still, I thought I would work on some stuff over the weekend.”

This was at the start of a hot August weekend. We were on vacation, supposedly. Was there nothing to do in New York City on one of the last free weekends we were likely to have for the next three years?

There is some evidence for the effect of chronic stress on health. This may be true. There seems, among other things, to be an adverse effect on cardiovascular health. But what is unquestionably true is that stress is unpleasant. We are stressed less by the particular circumstances of our particular job than by those irrational pressures that we put on ourselves. I would recommend studying the four categories I list above in order to judge better which things are worth spending time on—but I am afraid that those who are inclined to work too hard will find it is one more thing to concentrate on and worry about.(c) Fredric Neuman 2013  Follow Dr. Neuman's blog at fredricneumanmd.com/blog

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