The Flow State in Healthcare
You’ve probably felt it. Everything clicks. Your hands move almost automatically. The instruments feel like extensions of your body. You’re fully focused, precise, undistracted.
Mihaly Csikszentmihalyi originally coined the term “flow” in 1975 but his concepts gained wider appeal in his 1990 book: Flow: The Psychology of Optimal Experience. The worker becomes fully immersed in their task, entering a state of bliss, where the task seems almost effortless.
Csikszentmihalyi identified six elements that must be present in to enter a flow state. From Wikipedia:
Intense and focused concentration on the present moment
Merging of action and awareness
A loss of reflective self-consciousness
A sense of personal control or agency over the situation or activity
A distortion of temporal experience, as one's subjective experience of time is altered
Experience of the activity as intrinsically rewarding, also referred to as autotelic experience
That all tracks with my experience. In my dental practice, I would sit down to do a filling and enter a trance. I’m awake and conscious, but it felt like someone else would take over. My sense of self would retreat into the background and I’d operate almost on reflex.
I didn’t just feel flow for an individual procedure; I’d slip into a groove for an entire shift. Like many healthcare professions, dentistry often involves a provider bouncing from one room to the next, quickly shifting gears to tend to different patient needs. The day would just disappear, like I’d time traveled eight hours into the future.
The Upside of Flow
When you're in flow, everything gets better. Precision improves. Errors decrease. As a dentist, my eyes and hands would move seemingly without my active participation, like I had become a robot. Even better, a well-trained dental assistant and I could work together without a word, our hands in a silent ballet around the patient. In flow, you're fully tuned to the procedure, reading the patient’s responses instinctively, and making dozens of decisions without second-guessing yourself.
Flow isn’t just about technical performance. It’s also deeply satisfying. Many clinicians will tell you that those high-focus stretches— those hours that pass like minutes— are some of the most gratifying parts of the job. You’re using your full skillset, and it feels like you’re doing exactly what you were trained to do. For some, these moments are what keep burnout at bay. We leave our trance at the end of a busy day, proud of the teamwork and the patient outcomes.
What Makes Healthcare Flow Unique
I think flow in healthcare isn’t quite the same as in other professions. The stakes are higher. If a writer drops a sentence, they can go back and edit. If a surgeon slips, there’s no undo button. Every healthcare flow state carries a weight that demands vigilance.
There’s also the emotional layer. Unlike fields where you can focus on the task and shut everything else out, healthcare providers have to balance technical work with human care. The patient isn’t a widget; they’re nervous, anxious, maybe even scared. That emotional noise can disrupt that flow.
Patient interactions were tough for me in the early years, especially as I lacked confidence in my clinical skills. Eventually, I think I was able to enter into a state of flow with my pleasantries, case presentations, and even some tough conversations. When we’ve spent years doing procedures on live beings, we can master both the technical and the interpersonal parts of the job.
The Dark Side of Flow
Much has been written about the positive aspects of Csikszentmihalyi’s flow concept, but there has been less attention paid to the negatives. What follows is from my own experience and some sprinkles of speculation.
In a deep flow state, it’s easier to develop tunnel vision. You might miss cues that exist just outside the narrow field of focus, like subtle changes in a patient’s condition, a team member’s concern, or even your own creeping fatigue. That sharp focus around a routine procedure can act like blinders. Hyperfocus is a similar but distinct condition from flow that has been discussed with its negative effects (source). I think I occasionally slip from flow to hyperfocus and I’ll need to work on finding the right balance.
Another potential downside is the temptation to chase flow, to build your schedule or your practice culture around those moments of high-intensity work. I think that’s generally a very good thing; optimizing schedules makes care more efficient, productive, and interesting. But it can also quietly normalize unsustainable workloads. It’s okay to drive at 90 MPH, but the gas tank can’t be almost empty.
Here’s a unique risk for healthcare flow states: does prolonged immersion in the groove flatten our emotional engagement? You become efficient but detached. You start focusing on the technical task while emotionally distancing yourself from the human being you’re treating. Empathy fatigue can set in.
I think some healthcare providers need this to some extent. If you encounter death, grieving, emotionally abusive patients, and other harrowing experiences on a regular basis, then you have to build some protective layers around your own humanity. My wife and I have had to put down two cats over the past few years and I will be eternally grateful to the loving veterinary teams that helped us through those terrible times. I mean, how do they do that day in and day out and not quickly dissolve into sadness puddles? Achieving a state of flow could help these beautiful humans dial down their empathy just enough to do their job and not be eternally depressed.
My final flow concern is becoming emotionally detached from yourself. One of Csikszentmihalyi’s elements of flow is a “loss of reflective self-consciousness,” or as I’ve described it, letting the robot take over. In Let’s Talk About Depression in Healthcare, I discuss stress, burnout, and poor mental health states in our professions. Perhaps we can be so experienced at our jobs that when our reflexes take over, we don’t just lose our sense of self, we lose our sense of well-being. Our life gets into a such a routine that we tip our work/life balance too far to the former.
Finding Balance
The best healthcare organizations create environments that encourage healthy flow while building in guardrails. They hire enough support staff, build reasonable schedules, foster good team dynamics, and check in with clinicians regularly.
But the responsibility is ultimately our own. We need to be honest with ourselves about balancing our clinical proficiency with healthy levels of empathy and happiness. When we let the robot take over, it should enhance our skills, not replace our humanity.