Archive for the ‘Non-linear thinking’ Category

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Alicexz.deviantart.com

One of the interesting things about being in medicine is that friends and family consult you with all kinds of medical questions at any time. The questions span speciality (I was asked about a brain tumor, cramping and a bad cough in the same week!) Honestly, I enjoy it: it’s like an unplanned case of the day, and it’s a chance to be helpful. In many cases, I can simply put someone at ease. The movie “Dead Poet’s Socity” spoke about two kinds of professions, the “life sustaining” ones like medicine and engineering and the “life enriching” ones like literature, music and the fine arts. My reward in Acting was to (ideally) give my audiences a meaningful emotional experience by the end of the play through the life of my character, that is enrichment. In medicine, my reward is to use medical knowledge and skills to help patients feel better, sustainment. So, I appreciate the inquiring phone calls and texts and I would like to take you back to one in particular . . .

Last week, my sister texted me, concerned that her daughter (my ridiculously cute niece:) had a high fever and a cough. As I gathered the history and started working through the mental algorithms for what could be wrong, I happened to catch my niece’s voice in the background. She simply asked “What is that?” I think I have may have gotten more information from that audio signal than almost anything else in her story. Why? People who feel very sick are not curious. One of the things we learned in evaluating pediatric fever is that the exact tempertature is not as important as how the child appears. That takes observation, attention. I appreciate that because it feels clinical. A computer can work through algorithms but a only a clinician can be a medical Sherlock Holmes and notice personal, intangible atrributes that crack the “case.”

Paying attention matters not only in diagnosis but treatment. While on a neurosurgery service last year, I encountered a patient who required an operation to remove a brain tumor. Due to the tumor size and location, the patient had a devastating choice, to either lose the ability to read or to hear on that side, depending on which surgical approach was taken. Losing hearing or reading is more than a medical choice, it is a human one. One must ask the difficult question of which option would reduce one’s sense of self more profoundly. This question is approached by a patient who pays real attention to who she is, as well as family members and yes, doctors, who have done the same. No matter our profession, we will learn the same algorithms: law students learn the law, pharmacy students learn the drug mechanisms, but effective decision making in the grey areas seems to reward those who pay close attention to the nuances that no curriculum can adequately capture. Even in the enrichment professions, the actor who not only knows the lines but pays attention to the demands of the performance moment will respond with that spontaneous artistic choice that we recognize as brilliance . . .

By the way, I think we made the right call on my niece. She is doing well . . .

 

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Graphic credit: adventuresincommoncore.blogspot.com

This may come as a shock, but not every moment of parenting is filled with heroic deeds, warm hugs or high fives. There are tasks we parents do that won’t be making it to the big screen any time soon. One of those tasks is the parent-teacher meeting. It’s probably a good thing that this event won’t be a summer blockbuster. Not sure how many people would go and see the movie “Parent-Teacher Meeting: Goals Defined!”

And so it was that I drove over to my son’s school and sat down in his Math class, looking forward to meeting his teacher, but expecting a fairly generic description of the goals for the term ahead. But Mr. M surprised us all and instead whipped out a Math word problem for us to solve. But instead of jumping straight to a calculation, he got us to ask two questions “What do I notice?” and “What do I wonder?” This is the approach he takes with the students because of a growing revelation in education that many students do not know how to effectively approach verbal problems. They leap to calculation before really  understanding the problem. Asking what you notice and what you wonder first relieves you of the pressure to instantly be right and simply allows you to take in the information and process the problem in a non-linear way.

If there is one feeling you have in medicine, it’s the pressure to be instantly right. Even now, while I’m on research leave, I felt I needed to be correct when asked what I thought of the results I had just assembled for one of my research projects. But interestingly, my research group leader  used almost identical phrasing to Mr. M, the math teacher. She simply asked, when we were looking at the data tables, “What do you notice?” We are evaluating the literature to determine the effectiveness of a certain modality for treating nerve injury. I noticed that one muscle group seemed to improve much more than the others with this treatment. Why? (What do you wonder?) Could it really be that you can approach an 8th grade Math problem and a Neurosurgical research article with the same two questions?

And if so, where else could those questions be used effectively to solve problems?

What if spouses took the time to notice and wonder about each other? On second thought, there is probably a lot of noticing and wondering that goes on already “I notice you’ve walked onto the carpet with dirty shoes” “I’m wondering which couch you’d like to sleep on” but what if these questions were asked from a place of renewed curiosity and possibility?

With parents and children.

With employees and employers.

With ourselves.

We can get to the point where everything is about bottom lines and definitive answers. We stop noticing and worse, stop wondering. At that point, innovation is stymied, relationships stagnate and personal growth is stunted.

I first broached this question on Twitter earlier this week. As it happened, I have a mischievous friend who responded with a few notice/wonder questions of his own. I will leave you with one of his cheeky creations . . .

What do I notice? I can’t feel my foot

What do I wonder? If this crocodile will let go soon . . .