Which form of Competition is Best?

Just came back from watching my daughter compete in ballroom dance competition. It struck me as a cross between a swim meet and an evening at the theater. I can’t decide if turning an art and a pleasure into a competitive activity is a good thing, or not. 

Which got me thinking about medicine, as most things do. Because what we offer is such a scarce resource, we inevitably select people who are, quietly or openly, highly competitive. Then we continue to rank them, in tiny increments, right through the end of training. At the other end, the money and perks that go with practice, or not, seem to play right into the same attitude. 

On the one hand, competitiveness has made my daughter a fine dancer, and my own competitive streak keeps me pushing myself to accomplish things I might otherwise not. But I do wonder if the drive, not only to excel, but to outshine, is a barrier to learning really important things—like the value of doing something for its own sake, or just being with our families, our patients, the people we work with. By the time my kids finished swimming competitively, they no longer could swim for fun. As a friend, I never learned to hang out; now I only seem able to be friends with people while I am doing something. And much as I try to be receptive with patients, I keep them and myself to a very tight schedule.

What bothers me most is that medical students are so conditioned to rely on their competitiveness for motivation, they can quickly become indifferent or hostile to anything that does not seem to have immediate value for giving them a leg up. The idea of studying anything because it is of intrinsic interest, or might someday be useful, seems to fall away quickly in the first semester of school, and may never return. Since it is especially hard to compete on the basis of creativity, which, by definition, confounds existing standards, this, too, seems to be systematically discouraged in our students. Creative problem solving is an essential element of practice, not just a frill. But to ask “how can we reward creativity?” immediately puts us back in the position of selecting, rating, and favoring, the same dynamic that fosters competition.

Resigning totally from a competitive environment—the ashram approach—never appealed to me. It always struck me as a paradox of people competing to show how anti-competitive they were. I just wish our education—the one we had and the one we offer—allowed us to allow ourselves to freewheel more, and enjoy it. As recent posts and discussions have highlighted, being present in our immediate lives—reading chicklit, not postponing everything in hopes of a future haven, or choosing family time over work--is an important counterweight competitiveness as the root of our motivation, and our rewards.