Joy in medicine: unlearning

I was struck by Omolara Thomas Uwemedimo, MD, MPH's post this week. It resonated with my thoughts on where I was leaning to share this week in my "newsletter." Of course, if you have read my writings, you quickly learn they are less about "news" and more about sharing perspectives. Unlearning one's current perspective is likely the greatest gift received while practicing medicine.

How would you approach a parent of child with a broken arm versus a parent whose child has possible leukemia? The answer... if you think you know, you might need to unlearn a few things.

The impact of being humbled by another person's experiences or perspectives is profound. In medicine, like much of life, if your perspectives are not changing, then you really aren't paying attention. You are missing the opportunity to learn from "unlearning."

Why do we need to unlearn? I think Dr. Omolara sums it up so nicely. If you think you know, your focus limits you to just what you know. How do you discover new if you really believe that you are right? Common sayings in healthcare: "I was taught this way and this is the way," "This is how we do it here," "This is the way we have always done it," "I was raised this way or that way," "You would be better if you just listen to me."

As a physician, if I walk into a room and have pre-conceived ideas and render quick judgement based on my bias, then I will lose sight of what I could be missing. What if I don't consider what I do not know? I will hear less and not listen or learn what is the possibility. My questions will be biased, and I will lean toward confirming my bias. The bias often not only limits the diagnosis I have already but even more how I approach the patient or family. I have found that not only is my clinical acumen affected, but the outcome of my care is altered dramatically as well.

I have learned through humbling experiences that we all need to unlearn more. We all come from our own experiences, cultures, socioeconomics, on and on... These differences are why healthcare is so complex and far more art than science. True joy in medicine is found when you connect with a patient on their level and realize that they often have higher level thinking than you do.

What if we walked into every patient room as if we were open to learning? What could our patients teach us? What could we learn or unlearn?

From a personal perspective, I find this goal much easier to achieve when I just focus on the diagnosis. What do I need to think about, not miss, test for, and outline the right treatment plan? It's much easier to separate patients from clinical considerations. Easier than trying to really understand the patient's feelings, worries, fears or anxieties and achieving their trust. This area is where I struggle with more frequency than I would like to admit. However, what an amazing experience when one of my patients highlights my need to unlearn.

A most profound experiences as a pediatric emergency physician happened on a very busy Saturday afternoon about 20 years ago. I was swamped with patients, busily trying to juggle as many patients as I could and trying to track down labs and x-rays. In those days, X-rays were printed and placed on a lighted box for us to read. Labs were written on paper or faxed over to us. The day was spent running from one room to another while trying to keep up with results, making on-the-fly decisions, and keeping patients informed of results.

I had results on two patients that I needed to share. One child was a four-year-old who had fallen and hurt their arm. She was in the area on a trip and was flying home the following day. I perceived her to be educated, understanding, and reasonable, for some reason. The child had a minor broken arm and would need a cast for a few weeks but would not require surgery or suffer any long-term consequences. It was not a big deal injury, and she could travel home with no problem. I would give her these results before seeing the next patient.

The second child was much more ill. The child had been having recurrent fevers, weight loss, and was very lethargic. The child's activity level had greatly fallen off. He had been seen by a community health center and referred for more testing. The mom was calm but did not seem to recognize how sick her child appeared to be. My assumption was that she did not have a good grasp of the situation. I needed to better explain the results to her. I worried that the results, which indicated possible leukemia, would be overwhelming for her. I needed to slow down and prepare to deliver this news.

Early in my career, I did not yet understand how different every patient and parent is in my practice. This afternoon had a profound impact on my career.

I walked into the first room, X-rays in hand, and immediately told the mom that her son had a broken arm. She was immediately upset, crying and calling her husband to tell him the tragic news. I tried to calm her, show her the X-rays, and explain how "not a big deal" this news was, but she only cried harder and became more upset. I couldn't say anything to calm her. I spent ten minutes repeating, consoling, and talking with her husband on the phone. It was a challenging situation.

Time to re-group, I now needed to enter the next room. I was prepared for an equal or worse reaction. I sat down and talked with the mom. She listened attentively as I told her of my worry that this might be cancer. She understood and without emotion simply asked, "Ok, what's next, Doc?" I questioned if she understood, and she did. I outlined what would happen, and her response was, "Whatever we need to do."

These two interactions impacted me profoundly. Trust me, I have done much soul-searching on the "why" of my own assumptions. It's humbling to think about how my "learned" assumptions may have impacted me and my approach. These parents taught me to unlearn my judgment of parents and how they may react to news. They also pushed me to examine the why of my assumptions. Was it race, dress, appearance, insurance status, or something else that biased me in my approach? Was it my clinical bias or lack of understanding of how each and every patient's diagnosis and perception are different?

I missed wildly on my assumptions. I learned to change my approach by unlearning to assume anything. I have learned to see my patients differently with a goal to see them less as who they are in a visit and more as who and how they see the world. Patients have a perspective, and we need to re-learn with every interaction.

Thanks again to Dr. Omalara. You nailed it. Good luck to ChatGPT in understanding the complex challenges of providing real care to highly different patients, children and parents. Joy in medicine is finding the relationship to patients and clinicians. Clinicians who are willing to constantly unlearn and learn.

Note:?As a reminder this newsletter is written from my experience and perspective.?The newsletter does not imply or relay the opinions of others.??The intent is to offer an avenue for dialogue and discussion around important topics in healthcare and healthcare innovation from one doctor’s perspective.??I am a physician and so can only write from my perspective.?If you are clinician, provider, nurse or whatever my goal is to enable you to agree or disagree.?I have no intention to suggest or imply that only the physician perspectives matter.??They do matter but as part of a larger dialogue that can foster better health outcomes.?