We physicians can be very creative when it comes to preventing ourselves from studying. But those who suffer from pathological “procrastination” have a real problem and should do something about it.

Jan Mertens sighed. Once again a long night of studying lies ahead of him. On Monday morning at 10 am, he and his fellow student Sophie were expected to present the case of a medical patient and the corresponding disease details. Now, Sunday evening, shortly after 10 pm, he finally began to write down his notes. He was unable to do it any earlier, as he still had to look at the case file… Sophie was angry, because she wanted to go through their notes in the afternoon. “Don’t you dare let me down tomorrow”, she had said. No, he could not do that to sweet Sophie. He had also sincerely tried to be on time with his preparations. But after football on Friday he had been too tired. Saturday he had cleaned the bathroom and even ironed, and then that night’s party unexpectedly became so much fun that he reached his bed by dawn. But now it was going to happen! He would boil some water and get a cup of black tea, and then he would do it. Definitely…

Widespread problem

Deferring unpleasant activities – many people know this behavior, not only students or thesis writers: the bill for books always lies around until the second reminder. Even though it actually only takes three minutes to pay it, the bill is only picked up from the desk after three weeks. “Pathological procrastination” could actually be a real diagnosis. It has the Latin word “cras” in it, for “tomorrow”. The concept is therefore about “doing it tomorrow”. But defining when deferring becomes pathological is hard to say. One thing is clear: if one repeatedly pushes important things in such a way that it has a significant negative effect on one’s studies, profession or partnership, one should seek help. The psychiatry department of the University of Munster (Germany) surveyed cross-sectional students on this topic: extremely high procrastination values were found among 7% of them. Moreover, these values appeared to be even higher than with patients that were already being treated in Munster for their procrastination problems.

Result: self-doubt

Jan did the presentation. He even spoke calmer and clearer than the meticulously prepared Sophie. He was not allowed to gloat, but the fact that he had quickly scribbled notes on a paper during the night before made Jan proud of himself. He went home to sleep for the rest of the day. But somehow not everything went as smoothly as the presentation that semester. Jan, who had always been proud of his ability to grasp things quickly, failed several exams. “When I even had to cancel a vacation trip because I had to retake exams, I went to study counseling” says the doctor today. “I was quite at the bottom, seriously wondering whether studying medicine may not have been the right decision for me.”

More breaks and free days

In order to solve a problem, we normally start by looking at its root cause. But that is exactly the difficult thing with procrastination. While procrastination has similar consequences for those affected, the causes are diverse. The typical ‘procrastinator’ does not exist. It could be a wrong choice of study subject, but it could also be something else, like fear of failure, lack of concentration or an unrealistic expectation of one’s own performance. Even mental disorders, such as ADHD, anxiety disorders or depression may be the cause. Jan, who can remember more than a few cases of procrastination, cannot find a “main motive” for his postponements. “I did not have any Aha-moment or a particular Monday morning that changed everything”, he remembers. His salvation was that he realized his problem as such – and visited an advice center. “There I got tips on how I could gradually change my work habits.”

Before, the medical student wrote demanding to-do lists that he told himself to meet – which he never could. This resulted in him feeling like a failure every time. Now his to-do lists are becoming shorter and shorter, and he sees them more as a help with orientation rather than a must-do list. He divides assignments into several smaller ‘bites’ and is pleased with all of the things that he can do. In his study plan there were more breaks and free days. He divided the work load into more sub-steps and met with friends to practice. In order to be able to concentrate better, he found some relaxation techniques. But what really helped him the most was being nice to himself. “I learned that I had limits, and no longer tried to be a top athlete, party animal, and sample student at the same time.”

The ideal situation: a personal coach

Even though he was on his way, he was not completely ‘cured’. Nor did the stress suddenly stop. It still appeared that in January he had far too much test material and too little time. But at least he felt better and passed most of them. When the German medical exam drew nearer, it was mostly two fellow students that encouraged him: the once early riser Sophie, with whom he had fallen in love. And then there was Frederick. Ironically, he had to do his oral exam with this striver. “There was no way I was going to be worse than him” Jan remembers. And his efforts paid off: he passed the oral test with a ‘very good’.

Procrastination tips

Things that do not help:

  • Pulling yourself together right before the exam
  • Diverting from sleeping in order to study
  • Reading self-help books written by successful non-procrastinators

Things that do help:

  • Divide a big assignment into smaller ‘bites’
  • Always try to find one thing that is fun about the assignment, and starting with that
  • Set various smaller deadlines, that can be checked by friendly minded people; plan in enough breaks and rest days.


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