#10 - 22 November, 2023

CONTENTS

| ?? More Picasso than Poirot - the Art of Medicine |

| ?? Magicians and mental illness |

| ?? Details, details … |

| ?? Second helpings - good reading from the web |

LEAD ARTICLE

More Picasso than Poirot - the Art of Medicine

Sheer audacity! "He didn't even get up from his chair or lay his hands on the problem that I had come for. He glanced at me for a few seconds while talking on the phone to someone, then asked me two or three unfocused questions and said, 'Nothing to worry about; leave it alone." And he had the gall to charge me for this!"

The Sherlock Holmes fallacy. A good part of the mystique of being a doctor arises from the often repeated caricature of doctors as detectives: seeking clues, assembling them in logical order, and then deducing the diagnosis. The icon has been sustained and enlarged by the unfortunate association with the world's most famous fictional detective, Sherlock Holmes; his straight man, the physician Dr. Watson; and the characters' author, Conan Doyle, himself a trained and qualified physician. Note well that the doctor in his plots was not a very bright individual: a stodgy slogger called Watson, who is remembered for posterity as being the agent provocateur for the most misquoted Sherlock Holmes line, "Elementary". (Contrary to popular belief, Connan Doyle never added "my dear Watson", probably out of the realisation that Holmes' brilliant deductions would not be elementary to Watson's intellectual capabilities.)

Careful collection of fibres, tobacco dust, hair, and street dirt; the meticulous analysis of collected material through a magnifying glass; the hours spent thinking while smoking a pipe or screeching on the violin before the famous "Come Watson, the game is afoot" happened while Dr. Watson was snoozing on an armchair at 221 B or out pushing pills and prescriptions. Conan Doyle, with an insider's advantage, never credited healing professionals with powers of deductive reasoning.

The Art of Medicine

And it remains so to this day. The successful practice of Medicine is not solely a game of cold logic but one of pattern recognition and intuition, a sport in which the human mind excels—more Picasso than Poirot. Repetition alone seldom results in competence in this game. Like people who can recognise and name tunes in seconds, this is a gift that some have in large measure, the majority in modest but unpredictable amounts, and some not at all. The healing arts are no exception.

The winners. Talk to doctors about their college days and their class toppers, and, inevitably, you will hear that those who emerged on top of the academic heap are now, 20 years later, stagnating in relative obscurity; the chap whom hardly anyone knew has a roaring practice. The reasons are many, but if you look at those who are acknowledged as being successful clinicians, you will find a rather heterogenous collection with no common handle, maybe because skill at pattern recognition is a subtle, intuitive, behind-the-scene talent that is seldom overtly recognisable in an individual's personality. It is always tacit and sensed only by those who are close enough or intuitive enough to pick up this attribute in others.

This skill of sensing the patient's status is often manifest when a good doctor walks into a patient's room and immediately feels that all is not well. Her juniors and assistants will throw numbers and data that look normal, but the wise physician has this feeling of something being amiss.

Over the top. And then there are others who carry this too far. There used to be a professor in my medical college days who revelled in offering outlandish "spot" diagnoses all the time. Every now and then, he would pull a rabbit out of the hat, and the applause was deafening. No one ever kept track of the times when he pulled bloopers. The myth grew with time, and the man was something of a cult hero.

Empathy -- the secret sauce. This pattern recognition skill is even more important when dealing with the emotions and body language of patients. Ultimately, it is not the doctor's academic credentials that matter as much as the warmth and empathy that she can convey to sick people, a skill that cannot be taught in medical school. Empathy and the ability to listen carefully to what the patient is saying come first. The patient's story is the most true account, regardless of the rigid framework of history-taking that is dinned into medical students.

Hidden in plain sight. Combine the two - pattern recognition and empathy - and you have the makings of a great doctor. Medical colleges never teach or even mention these skills. No surprise, then, that young doctors graduate and wonder why the world doesn't look like what they were shown.

A deep sense of wonder, a firm grasp on reality: what magicians can teach us about mental health

Ormerod P, The Guardian. November, 2023.

Everyone loves magicians and magic shows. Reality is suspended for the duration of the performance. It appears that professional magicians are unique in their resilience to emotional illness. Peter Ormerod delves into the special status of magicians as artists who live on paradoxes and have a profound comprehension of reality.

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• A breed apart. Artists, in general, are perceived as emotionally distressed humans. In contrast, researchers at Aberystwyth University found that magicians are less likely to experience mental health problems. Their trade necessitates a strong understanding of reality, human perception, and the limits of human belief.
• Understanding reality via illusion: Magicians work to create illusions that defy natural principles, yet their craft necessitates a keen understanding of the limits of human belief and potential.
• "Honest dishonesty." Their work is characterised as sophisticated theatre wherein the magician and audience both voluntarily participate in the illusion despite being aware of it.
• Secret sauce. The magician's lifestyle emphasises community, exercise, education, generosity, and mindfulness — similar to suggested practices for mental wellness.
• "Extraordinary normality."This groundedness in reality, along with a sense of wonder and an acute awareness of what is real and what is imagined, raises the possibility that magicians may really be able to unlock the door to a kind of mental health known as extraordinary normality.

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“Scientists have calculated that the chances of something so patently absurd actually existing are millions to one. But magicians have calculated that million-to-one chances crop up nine times out of ten.”?―?Terry Pratchett

The truth is always made of details

Raptitude, Cain D. October, 2023

The famous architect, Mies van der Rohe, held that "God is in the details." We often forget the incredible complexity that lies behind everything we encounter. Stopping to examine them can be a very enlightening exercise.

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• Details have no limits. Close scrutiny of a leaf reveals complex serrations, veins, and capillaries in addition to its basic form. This intricacy, embedded in all objects, exists in an almost limitless regression, far beyond human simplifications.
• Human perception has a small bandwidth. Humans' 'zoomed-out' worldviews allow them to effectively carry out routine activities. It is always possible to "zoom in" and focus on specifics. Watching a football game, for instance, displays not only two teams but a plethora of individual athletic performances, all of which have their own subtleties. ?
• Deep dives. The essay indicates that going under the surface to examine finer points is the key to unlocking a deeper comprehension of any topic. One can use this method to explore both tangible items and abstract concepts and problems.
• Information age challenges. The author cautions against simplifying in a time when superficial analyses of complicated problems are the norm. Overstimulation from social media can lead to simplistic assumptions about the world that ignore its intrinsic complexity.
• Raising the bar on the default resolution of our interactions better reflects our intrinsic capacity to pick up on nuances and complexity. This perspective acknowledges the infinite resolution of the universe and its minutiae.

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“My religion consists of a humble admiration of the illimitable superior spirit who reveals himself in the slight details we are able to perceive with our frail and feeble mind.”? ―?Albert Einstein

“Details matter, it's worth waiting to get it right.”? ―?Steve Jobs

SECOND HELPINGS

Good reading from all over

1. Plant-based swaps may cut diabetes and heart disease risk, major review finds
2. Compassion fatigue can happen to anyone — here’s how you can overcome it
3. Does screen use really impact our thinking skills? Our analysis suggests it could
4. The surprising link between music and focus could make you more productive than ever
5. The origin of the word “Dude”
6. Is there a way to make meetings more productive, focused, and creative--and increase your happiness and longevity? Surprisingly, Science says “Yes”