The show must go on: Addressing human factors in performance

Saturday, June 20, 2015 | 0 Comments

Before his death from AIDS in 1991, Queen frontman Freddie Mercury recorded the vocals for what would become one of his most enduring anthems: “The Show Must Go On.” The message—and the context—of the song capture my observations of what it takes to be a physician.

It means being ready to perform no matter what.

Whether you are fatigued, stressed, unsure about what’s in front of you, or fearful of what might happen, the expectation from those you serve is simple: you will rise above circumstance and deliver.

On the threshold of death, Freddie Mercury knew what was expected of him—a brilliant performance—and he delivered. Somehow he found a way to avoid letting himself (his fears, his anxieties, his anger) get in the way of his job. And that is what we are here to help you achieve as well.

Below is a snapshot of some performance preparation techniques that have been demonstrated to enhance poise, perception, energy, awareness and adaptability (to uncertainty and unanticipated events) for human performers in medicine and other fields. By adding them to your preparation routine, they will help you enhance your focus and feel—two key factors to achieving sustained high performance.


  • Identify situations you know have the potential to disrupt your focus, mood and energy. And anticipate challenges you might encounter in the future.
  • Reflect on the conditions (internal and external) that precede moments where you feel optimal or abysmal.  Get clear on where, when, and why you are susceptible to these thoughts and feelings.
  • Be mindful as well of those things that create the optimal feel and focus you desire. Review and reinforce them as you are readying to perform.
  • With this information you can develop a blueprint of new response patterns to the thoughts, feelings or situations that prevent you from performing at your best.


  • Get a picture in mind of what you want to feel, experience, create or achieve. Then plant the seed. What you think and what you say to yourself will reinforce your vision and help it grow—whether it’s for a day plan or for a specific moment or situation.
  • Feed your conscious mind with ideas that capture how you want to feel. The subconscious is fed by your conscious, habitual thought patterns—so speak with conviction, no junk food!

Emotional preparation

  • Learn to trigger feelings that might arise through visualization
  • Rehearse optimal responses in those same scenarios
  • Then see and feel the solutions you develop with each mental repetition.

Situational stress management techniques

  • Deep breathing: Take three deep-centered breaths to reduce your stress response.
  • Cognitive reappraisal: reframe the situation you have or may encounter and then draw in additional information to counter distracting and destructive thoughts that may arise.
  • Reinforce ideas about your strengths, capabilities and experience, and ask for support from those around you.
  • Change your posture: Head up, chest out, shoulders relaxed. The way you carry yourself signals confidence and poise to your mind.
performing under pressure
emotional preparation
stress management

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