Healthcare Practitioners “Surfing” to Optimum Performance

By Bonnie Hutchinson

To see Steven Kotler now, you’d have a hard time imagining that he once made what seemed like a perfectly rational non-emotional decision to end his life.

Award-winning journalist and speaker, Steven Kotler is best-selling author or co-author of books such as The Rise of Superman, Abundance, Bold and Stealing Fire. He’s steeped in science, technology and rigorous research. His presentations and interviews pulsate with vibrant energy. He’s wickedly funny.

That was not always so.20


As a young man, Steven Kotler moved from San Diego to Los Angeles to live with the woman he planned to marry. His career was flourishing. He was happy.

And then he was not.

He was struck down by a debilitating illness that completely sapped his strength and coordination. He couldn’t walk. He was in constant pain. Even worse for someone used to having a brilliant mind, he could not think.

It took a long time to obtain a diagnosis. He had Lyme disease.

You’ve probably heard of it. Apparently caused by the bite of a tick, the impact is brutal. Shooting pain, numbness or tingling in the hands and feet. Rashes. Vision changes. Inflammation of the brain, spinal cord and joints. Loss of muscle tone. Heart palpitation or irregular heartbeat. Facial paralysis. Fatigue, headaches, vertigo, mental confusion. And oh yes. At the time Steven Kotler was stricken, no known cure or even treatment.

He could not work. He could not support himself or even care for himself. The woman he’d planned to marry left. As far ahead as he could see, he would be nothing except a burden.

After three years of languishing in bed, he made what seemed like a rational and unemotional decision to end his life. He had the pills and the booze…


That was awkward. He hoped she didn’t notice the pills and the booze.

His friend said, “We’re going surfing.”

The idea was ridiculous. He couldn’t even walk. How would he be able to surf?

His friend was relentless. Kotler says, “I finally realized she just wasn’t going away. And I thought, ‘Well, I can always kill myself tomorrow…’”

His friend and a helpful neighbour managed to maneuver Kotler into a car. They drove to a beach with smallish waves. (He describes it as a beach where no self-respecting real surfer would go.) With help, he somehow managed to get on the surfboard and catch a wave.

And magic happened. He could ride the wave.

He experienced transcendence. He felt at one with the wave; lost all sense of self; had no thoughts; was just totally immersed in the experience, beyond joy. He’d never felt anything like it before.

He wanted that experience again. His friend agreed to take him surfing the next day…


Fast forward. Within eight months, he had recovered about 75% of his previous capacities. No, there was no new medical treatment. He attributes the remarkable improvement to surfing, or more precisely, to the amazing flow that he experienced while surfing.

It took about another five years before he was back to the level of functioning he had before Lyme disease. But he had a life back.

Since then Steven Kotler has been a passionate researcher, writer and teacher of flow and peak performance. Along with Jamie Wheal, he co-founded The Flow Genome Project[1] which is dedicated to mapping the deep science of ultimate human performance. One of the reasons Kotler and Wheal began the Flow Genome Project was to bring together all the flow researchers and research under one giant tent.


Great story. What’s the relevance to healthcare practitioners?

The flow state is an optimal state of consciousness – the state where you feel your best and perform your best.

As a healthcare practitioner, you’ve almost certainly had times when you were in a state of flow. Those times may be among your favourite aspects of being a healthcare practitioner. The more you can operate from a flow state, the better you perform. That’s not only rewarding for you, it’s the state in which you will be of greatest benefit to patients.

So what are the characteristics of the flow state, and how do you get there?


Mihály Csíkszentmihályi has been researching the flow state for more than 30 years. He describes the mental state of flow as “being completely involved in an activity for its own sake. The ego falls away. Time flies. Every action, movement, and thought follows inevitably from the previous one, like playing jazz. Your whole being is involved, and you’re using your skills to the utmost.”[2]

Characteristics of being in the flow state include…

  • Strong concentration and focused attention.
  • The activity is intrinsically rewarding – not a “means to an end” but rewarding in itself.
  • You’re totally immersed in the experience. Everything else disappears.
  • Timelessness; a distorted sense of time; feeling so focused on the present that you lose track of time passing.
  • Loss of a sense of self – you’re just part of a bigger experience.
  • Lack of awareness of physical needs.
  • Feelings of serenity.


Steven Kotler says, “Pretty much every athletic achievement is a flow state. Major scientific breakthroughs emerge out of flow states. Same thing with significant progress in the arts. Flow is one of, if not the greatest driver of innovation.”[3]

So how do you get there?

Conditions that help you get into the flow state include …

  • Clear goals that, while challenging or a bit of a stretch, are still attainable. Vishen Lakhiani, CEO of international learning organization Mind Valley, says a 4% stretch is optimum (about 4% more challenging than what you know you can do). That’s enough to be a challenge – with touches of excitement – but not so much that it’s overwhelming.
  • Whatever you’re doing is part of a larger purpose or meaning; it feels worthwhile.
  • Knowing that the task is doable; a balance between skill level and the challenge presented.
  • Immediate feedback. You know you’re doing the right thing OR you know how (or have help) to course correct.

Jamie Wheal adds another dimension he’s observed from the research. “The people who have the most flow in their lives were and are the happiest people in the world. And the way they got there was to build their lives around it.”[4]


The mission of Hone Virtual Education is to help you save lives. And one way is to help you be in a state of flow in the first few seconds of patient contact.

As the Hone website says, “Our mission at Hone is to help practitioners perform at peak levels, capable of rapidly and correctly identifying diagnostic cues, enabling correct clinical decisions.”

A crucial aspect for healthcare practitioners, especially those who practice emergency medicine and/or who practice outside of medical facilities, is what happens in the first few seconds of patient contact. If ever there was a time to be in a flow state, that is the time. As quickly as possible, you need to assess patient airway, breathing, circulation, disability and environment, so you know how to respond.

There’s no time for a checklist approach. You need to “get it all” immediately. You need to be in the state Csíkszentmihályi described, where “Every action, movement, and thought follows inevitably from the previous one, like playing jazz. Your whole being is involved, and you’re using your skills to the utmost.”[5]

One of the ways Hone helps you do that is through virtual simulation training modules that you can download to your augmented-reality-enabled smartphone or tablet. The first modules focus on helping you quickly identify the diagnostic cues you’ll see in medically accurate avatars. The avatars show varying degrees of distress and you identify the level of severity. You’ll get instant feedback, and immediately know how to correct any errors. You can practice as often as you like until you achieve accuracy. Then the pace speeds up to help you get faster and faster at correctly identifying “illness cues” and “illness script patterns.”

As you can see, Hone’s virtual simulation CUE recognition training modules provide “flow” conditions. You’ll be stretched – not too much and not too little. It’s a worthwhile activity. You get instant feedback. You’ll know you’re improving in one of the most important skills you can have as a healthcare practitioner.

You’ll be in a state of “diagnostic flow.”


Hone Virtual Education will soon be releasing modules on apps available from Apple stores. Meanwhile, at you can…

Learn more about Hone Cue Recognition virtual simulation training.

Be notified of updates and launch dates.

Apply to be a beta tester as new modules are developed for health practitioners in high pressure environments.


Bonnie Hutchinson is a writer and lifelong learner with degrees in Education and Whole Systems Design as well as extensive training and experience in adult learning and teaching. As an organizational and evaluation consultant, she’s worked with many healthcare and healthcare practitioner organizations. She’s bestselling author of Transitions: Pathways to the Life and World Your Soul Desires.



[2] Mihaly Csikszentmihalyi (1990), “Flow: The Psychology of Optimal Experience,” Journal of Leisure Research, 24(1), pp. 93–94, quoted by Kendra Cherry |Reviewed by Steven Gans, MD (2018), “Flow Can Help You Achieve Goals: Understanding the Psychology of Flow,”

[3]  Flow Genome Project – the Documentary,

[4] Flow Genome Project – the Documentary, op. cit.

[5] Mihaly Csikszentmihalyi (1990), op. cit.


Hone CUE Recognition on the App Store

The Hone CUE Recognition App will soon be available on the App Store for early adopters. When it is available - you will be able to download it via the link below.