From time to time, I speak with physicians who are highly motivated to get into another business, but that is about as far as their enthusiasm takes the. They have the desire -- and can't muster up anything more. They are immobilized with indecision about what business to start. Several ideas have appeal until they are investigated further, and then suddenly they lose their lustre.

What is stopping them from taking the plunge? And what is to be done?

I suspect that any one or more of the following are flaring up:

1. Difficulty with tolerating the unknown: As physicians, we necessarily require a low tolerance for uncertainty. It is what urges us to relentlessly pursue the diagnosis until it is known. This attitude, however, costs us dearly when it comes to exploring options that affect our lives and livelihood.
   
2. Risk-aversion: Perhaps this originates in our choice of profession and the self-selection involved. Medicine is generally thought to be a "safe" career with a guarantee of employment.
   
3. Habitual thinking: We get lazy in our thinking - habits are easier to adhere to than to break.
   
4. Lack of confidence: It's hard to picture a physician truly lacking confidence as the demands of the career require a certain level of self-esteem. Instead, what I think what is at play here is a concern about not making the perfect decision. The one we know is absolutely right for us and guaranteed to produce a successful outcome.
   
5. Avoidance of taking responsibility: This is where we get to play the victim of our circumstances and sidestep the challenge of taking ownership of our lives and choices.
   
6. Confusion: A truism is that the confused mind always opts for "no". It's the safest way out of a mental challenge.
   
7. Expectations: This is on a par with habits. We get used to having our expectations met at a certain level -- financial, lifestyle, social, psychological -- and it is uncomfortable imagining living with anything different or less.

The unifying emotion in all seven circumstances seems to be fear!

Well then, how can one overcome fear, and create enough mental and spiritual space to foster the opposite - courage? 

In this article on positive psychology and courage from PsyBlog, "How to Build Courage Through Personality Traits and States of Mind", the author British blogger Jeremy Dean reviews a new model of courage and offers suggestions as to how to increase the positive factors that promote courage.

The factors from the blog post are (I encourage you to read the article for details as it is very helpful):

Courageous character traits

1. Openness to experience.

2. Conscientiousness.

3. Core self-evaluation

Courageous states of mind

1. Self-efficacy.

2. Means efficacy.

3. State hope.

4. Resilience.

Convictions and social forces

1. Inner convictions.

2. Social forces. 

My take on how to overcome the negative forces is to do what one client has opted for:

• work hard to set up a situation that allows time for reflection, thinking and for simply being.
• be willing not to know immediately
• trust that the subconscious and conscious minds are deeply engaged with the questions that matter
• find a "thought partner" who is equally comfortable sitting with the unknown and doesn't feel impelled to do the "doctor" thing and rush in and fix it
• become a doodler, journaller, list-maker, vision board creator. If you have to do something, let it be unstructured, random, irrational
• get physical - ride a horse, go for long walks, do yoga, jog, go kayaking

When you are feeling stuck, what works for you?