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A Brain Surgeon's 3 Tips To Achieve Peak Performance Under Pressure

Mark McLaughlin, M.D.
Board-certified neurosurgeon By Mark McLaughlin, M.D.
Board-certified neurosurgeon
Mark McLaughlin, M.D., is a practicing board-certified neurosurgeon, a national media commentator, and author of the book Cognitive Dominance: A Brain Surgeon’s Quest to Outthink Fear. He is the founder of Princeton Brain, Spine, and Sports Medicine where he practices surgery focusing on trigeminal neuralgia and cervical spine surgery.
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We all have ways of getting through difficult or pressure-filled events, each uniquely suited to who we are. But sometimes our coping mechanisms have just happened—they haven't necessarily been thought through even though they might work in the moment. 

As a neurosurgeon, I've noticed three critical fundamentals that I've honed in surgery that I typically rely on when fear, personal challenges, and high stakes all intersect.  

Be rest assured, these tips are adaptable to any situation, even when the stakes aren't so high (at least, not as high as brain surgery). Whether you're entering an emergency room or simply having a difficult conversation with a dear friend or significant other, here are three tips that can help you stay grounded in the face of pressure: 

1. Step into a routine.

When you have a routine, your sense of control increases, and you can get into a focused mind space more effectively. Routines are actions that put you into the right mindset. A good mindset doesn't come first. Actions come first, and the mindset follows. That said, here's what I do before every surgery.

When I enter the operating room (OR), I arrange my personal equipment: setting operating glasses on the counter, arranging my cool suit (I get sweaty in the OR so I wear a device similar to what race-car drivers wear that blows cool air on my body while operating), and review my surgical planning sheet.

Then I say hello to everyone by name (a respected leadership skill). I then confer with my assistant scrub nurse who will be handing me instruments, rehearse every step of the surgical plan with the team, and check that all of the instruments are laid out. I've found that the surgery goes much more smoothly if you communicate with your team every single step of the way. I do not move forward until all of my items are in order and this routine has been carried out.

Even if you aren't stepping foot into the operating room, take some time today to think through your routines before an event that requires your best performance. What are the elements? Do they all work? Are there ways to modify them to provide you with even more support? The more thoughtful you are about what you need to prepare yourself—and implement those routines—the better you will perform.


2. Review your safety hatches.

Before I go into any operation, I review with myself what could possibly go wrong at each step of the operation. I have rehearsed these types of "fire drills" thousands of times during my training and now in practice, but it's important to cue them up again before the procedure just so they're fresh. 

I ask myself what I would need to do to get back on track, back to the flow of the surgery, if something unexpected happened. Whatever it might be, whether it be a patient's excessive bleeding or unstable vital signs, it suddenly seems impossible and scary to achieve the desired objective. A natural first instinct is to want to back out or abort the procedure altogether, but because I have prepared for these scenarios, they somehow become less worrisome, as if they're behind me. I consider them only in the laboratory of my mind. That way, in the unlikely event they occur, I'm prepared.

That said, it might be worth it to create some safety hatches in your prep procedures. How do these safety hatches benefit you, the people you work with, the people you love? Whether one's tools are mental or physical—or often both—it's important to keep them sharp and ready. 

3. Have faith.

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I pray before surgery. I believe it makes me a better surgeon. To note, having faith doesn't necessarily have to be religious. In fact, I believe that when you're part of a team, you are expressing a form of faith. The act of joining a team means that you have subordinated your personal goals to the goals of the team. In essence, you have chosen to be part of something bigger. And when you are part of something bigger, you tend to show up more fully and perform at a higher level because others depend on you.  

When we collaborate, we experience the release of a feel-good hormone called oxytocin. It can carry us to higher levels of performance because it enhances trust-building and social cognition. A strong support system or team can always surpass an individual's best performance. Be mindful of how you can leverage your faith in those you work and live with to get more out of yourself.

Even as we try to be mindful, strive to be at our best, it's still easy to forget the basics that can help us achieve success. That's why I live by these fundamentals, and in practicing them daily, in all situations, they have become part of who I am, as natural and essential to my life as breathing. Routines and habits might be seen as boring, the sign of the unadventurous or staid. For me, they provide support when I am forced to take chances, face life challenges, and must perform at an elite level. As you think through your own steps taken to reassure and prepare yourself and those around you for a challenge, I hope my experience can provide some assistance.

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