New Year's resolutions

New Year's Day is nothing but an arbitrary day that, for instance, was celebrated by the Babylonians at the new moon after the spring equinox (and next year, the 1 Nisanu 2631 will be on what we call 9 April 2005 (www.cf-software.com/other.html)). On 1 January no check, no pause, no planetary escapement in the celestial clockwork will take place as our planet spins relentlessly around its sun. Its only importance is for the human mind.

A complex history places New Year's Day just seven days after the great religious and commercial festival of Christmas. The week between Yule and Hogmanay is known in German as zwischen den Jahren (between the years), the magical period when little work gets done, next Christmas is a year away, and there is time for reflection. And since “to make an end is to make a beginning,” as T S Eliot said, many new beginnings are resolved in those days. “Hell,” though, according to St Bernard of Clairvaux, “is full of good intentions or desires,” many no doubt being failed New Year's resolutions. Bridget Jones began her famous diary with 33 resolutions, and 364 days later wrote, “Number of New Year resolutions kept 1 (v.g.). An excellent year's progress.”1

“Must emigrate” will be a resolution of many young doctors in the United Kingdom, if one can extrapolate from a recent study in which 66% “did not definitely intend to practise medicine in the United Kingdom for the foreseeable future.”2 However, as a commentator asked,3 do junior doctors actually do what they say? Longitudinal data show that many do not.4 When do intentions predict behaviours?

Some intentions definitely predict actions. My intention to write this editorial resulted in action, and I expect action from the editor's intention to pay me. Everyday life relies on intentions predicting actions: “I intend to cook dinner; I intend to collect the children from school.” Some career intentions by doctors also predict actions, as in another study from the UK Medical Careers Research Group, 64% of graduates intending to be psychiatrists were practising in psychiatry 10 years later, compared with 3% of those preferring other specialties.5

However, experience tells us that even strong intentions need not result in action. Many patients intend to give up smoking, drink less, and exercise more, and yet no action occurs. Such gaps between intention and behaviour6 are the outcome of most New Year's resolutions. Even given the limitless human capacity for self deception, why do intentions sometimes not result in actions?

Sometimes intentions are not intentions, but are actually desires: “Arthur desires to leave medicine but does not intend to do so.”7 Freud emphasised that human behaviour is overdetermined, many factors motivating or discouraging even simple actions. We all have Walter Mitty fantasies, and some of the multitalented people who become doctors will inevitably speculate about alternative careers. Such needs, motivations, and desires may ultimately surface through a change of emphasis or direction within medicine.

Intentions can also be a cry for help, most obviously in a patient's stated intention to commit suicide. Questionnaire surveys, like protest votes at elections, allow a non-committal expression of discontent. Surveys on stress in doctors often find high apparent rates of psychiatric caseness, but formal psychiatric evaluation finds a low validity for such cases,8 as single issue questionnaires inflate apparent dissatisfaction and unhappiness.

Even the most solid of intentions can fail, as the fickle finger of fate causes “a slip ‘twixt cup and lip.” Some people, however, have more slips than others. People differ in their tendency to procrastination,9 and procrastination is particularly easy without a precise time window. How many doctors would have answered definitely if asked, “Are you intending to leave medicine in the next three months?” And how many would have signed a resignation letter dated three months hence? Intentions are anticipations of the future, and people differ in the perceived costs, benefits, and consequences of possible actions. Every action is another action denied, and the anticipated regret for lost possible futures may itself inhibit action.

Intentions are private mental events, and actions alone cannot tell us about them, particularly if the intention is to mislead about true intentions. Observers can also mislead themselves by wrongly inferring intentions from behaviours: “You never said you wanted to leave so we assumed you intended to continue practising as a doctor.”

My intention is not to make any New Year's resolutions—interpret that as you will.