What’s Your Plan (and Does it Matter)?

August 5, 2016

Making a plan, or not, in radiology and life.

The other day, as I was setting out on my usual pre-work run, I noted I was in an unusually good mood. I’m not always a sourpuss when I force myself awake two hours earlier than completely necessary in order to huff and puff my way through 6-7 hilly miles before settling in for a 10-hour stint of work...but I’m not typically Mr. Sunshine at the time.

Having a certain compulsion to practice metaphorical dentistry on gift horses, I couldn’t just enjoy the cheeriness at face value, and was prepared to spend some of the hour’s exercise introspecting as to its source. It didn’t take long: The reason was that I had a plan for my after work hours that evening.

It wasn’t much of a plan, granted; just specifics as to what I was doing for dinner, and returning a phone call I had recently received. Usually, after finishing work, I have all of 3 hours before I need to get to sleep, and that slice of time is typically a blank canvas…which I tend to prefer, what with the other 21 hours of the day pretty much spoken for.

Evidently, even the small matter of having a plan for what I was doing about 12 hours subsequently was pleasing to some part of my mind other than the part that jealously guards its free time.

In truth, we’ve got plans for everything. I’m not saying they’re all good ones, nor well thought out or even something consciously thought of. Even deciding to “wing it,” entering a situation without any forethought or other prep, is essentially planning not to have a plan. The moment the situation is manifest, however, one is planning on the fly, acting on instinct, reflex, habits, etc. I’ve spent entire vacations proving this to myself.[[{"type":"media","view_mode":"media_crop","fid":"50791","attributes":{"alt":"Planning in radiology","class":"media-image media-image-right","id":"media_crop_7755672322296","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6221","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 128px; width: 171px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Albina Glisic/Shutterstock.com","typeof":"foaf:Image"}}]]

We like plans, even just the notion of having them. Politicians routinely get themselves elected by saying things like “I have a plan,” even if they never spell out what the plan is. Fictional villains (James Bond nemeses leap to mind) entice audiences to pay attention for 2-3 hours at a time because they have diabolical plans for the good guy to thwart. Entire industries are based on the notion that you, the customer, will shell out your hard-earned dough to be covered by one of their plans (insurance, investment, timeshares, you name it).

As entangled in plans as we are, we also seem to be jaded with them, or enamored with the concept of their failure. There’s no shortage of truisms in this regard: “No battle plan survives contact with the enemy.” “The best-laid plans of mice and men…” “Man plans, and God laughs.” In fiction, it’s almost a guarantee that if the audience learns the details of a character’s plan of action, subsequent scenes will show the plan encountering difficulty, if not failing entirely. (Those James Bond villains mentioned above generally only fail after they have explained their master plans to 007.)

I’ve had more than a few plans during my career, predating even my plans to compete for positions in radiology residency and fellowship programs. Plans for location and type of post-training work. Plans for pursuing partnership, plans for what I’d do after attaining it, and contingency plans for if/when partnership turned out to be an empty promise. Getting into teleradiology was something of a leap of faith at the time; it panned out well for me, but I had backup plans if that didn’t go well.

Beyond the individual level, the complexity of plans skyrockets, because there are so many more variables; how can anyone hope to consider all of them? Which doesn’t stop us from trying to plan for changes in reimbursement, regulation, study volume, demands of referring clinicians and facilities, the job market, advances in technology, etc.

How worthwhile is it, making all these plans when there always seems to be some unexpected variable? Well, there’s the sense of comfort I referenced at the beginning of this column; that’s a nice benefit as long as one doesn’t get too smug and off-guard that one has all bases covered.

Even if when plans fail spectacularly, they aren’t necessarily a wasted effort. The time and thought put into them will surely pay some dividends when one has to come up with a last minute Plan B, or may even be of use in matters unrelated.