Each state of mind is equally important to achieving personal and professional success
Surgeons love to plan—there is security and familiarity in the rigidness of structure. But how often do we take the time to dream? Or form intentions?

All too often, surgeons overvalue the importance of planning at the expense of dreams and intentions. In reality, all three are equally important in shaping our success, and we must embrace all three if we are to reach our fullest personal and professional potential.

Dreams
Because it is free, unencumbered, and limitless, dreaming is how we get to the core of what we want. In a world that's cluttered with different inputs and influences, dreaming is something we can truly do on our terms. It flows naturally from within, not from the persuasions of friends, family, and colleagues.

When we dream, our hearts—not our minds—lead us. That's why dreaming is so important. It allows us to reengage with our passion—the reason we got into surgery in the first place—and through that reengagement, achieve measurable performance improvement.

Intentions
Dreams are important because they enable us to tune into our truth, but they rarely become reality. That's where intentions come in. Intentions straddle the fence between dreams and plans. Intentions are more focused than dreams, but, unlike plans, intentions lack concrete steps or timelines.

It would be amazing to help set up a surgical clinic in Haiti. This is a dream (for some of us). It is entirely open-ended and devoid of any substance.

We're going to travel to Haiti to help set up a surgical clinic. This is an intention. Yes, it's detail-free, but there is hope and focus behind it. We are going to do it versus it would be great if we could do it. See the difference?

Where a dream is an expression of desire, an intention is a promise of action—an open-ended commitment to an outcome that doesn't outline the how or when for achieving it. The how and when are surrendered to the universe.

Intention setting is tough for surgeons because it requires letting go of control. In our profession, remaining in control—of our emotions, our hands, our minds—is a mandate. We actively create safety nets and redundancies to avoid the loss of control at every turn.

But the absence of control is the value of setting intentions. When things are beyond our control, they don't actively place stress on our lives. The less stress we carry, the better our attitude becomes. And the better our attitude, the more energy we have to stay healthy and have more fulfilling, sustainable, and lifestyle-friendly surgical practices.

Plans
Finally, plans are simply intentions expressed in the finite and concrete. Nothing is open-ended. Nothing is left to chance. As surgeons, plans are the most native of the three practices presented in this article.

Plans, with specifically outlined goals, are how we inspire and influence ourselves and others. Plans are how we reduce complex problems to executable strategies through simplicity. Plans are rooted in reality and burdened by actions, timelines, and metrics of measurement. Unlike dreams and intentions, which are functions of the heart, plans are actions of cognitive reasoning. We control our success or failure from start to finish.

But in a world littered with distractions, plans can easily get disrupted and fall by the wayside—a frustrating, discouraging experience—unless we employ strategies that allow us to reassess and recommit.

Intentions and dreams will not fall by the wayside because they're not connected to timelines or steps. They either happen or they do not happen—that is their advantage. Intentions and dreams don't usually lead to disappointment. As surgeons, we must recognize this difference. If we want to be healthy and happy, we must stop trying to fit everything in our lives into the construct of a plan.

Final thoughts
Plans are not the enemy. That should not be the takeaway of this article. Plans play an important role in determining our professional success and personal happiness.

But plans aren't without limits or ill effects. They can drive stress, elevate pressure, and can fail.

As surgeons, we can benefit greatly from proactively layering dreams and intentions into our plan-laden lives. There really is a role for all three—we just have to recognize it. Now, try mixing each of these three elements into your life and career.

Jeffrey M. Smith, MD, is an orthopaedic traumatologist in San Diego.