June 12, 2018

Gawande: Curiosity is under attack—and without it, doctors 'lose our humanity'

Daily Briefing

    Atul Gawande in a commencement address at the University of California-Los Angeles' David Geffen School of Medicine earlier this month recounted treating a prisoner while he was a medical student, urging the graduates to remain curious about others' lived experiences in order to deliver on the medical principle "that all lives are of equal worth."

    How to address health inequity in your community

    Treating a prisoner—and discovering the importance of curiosity

    As a third-year medical student, Gawande recalled, he followed the chief resident, an Asian-American woman, to see a patient—a prisoner who had swallowed part of a razor blade and cut his wrists. The patient, Gawande said, "was about 30, built like a boxer, with a tattooed neck, hands shackled to the gurney, and gauze around his left wrist showing bright crimson seeping through."

    When the prisoner first spoke, "he managed in only a few words to be racist, sexist, and utterly menacing" to the chief resident—who in response "turned on her heels" and "handed [Gawande] the clipboard," saying, "'He's all yours.'"

    As Gawande treated the prisoner, Gawande at first "only saw a bully." The prisoner "kept up a stream of invective: about the hospital, the policemen, and the inexpert job I was doing," Gawande said. He added, "I had the urge to tell [the prisoner] to shut up and be a little appreciative."

    However, Gawande also noticed that the prisoner "controlled himself enough to hold still for my ministrations"—and, at that moment, Gawande said he "suddenly remembered a lesson a professor had taught about brain function." Gawande explained, "When people speak, they aren't just expressing their ideas; they are, even more, expressing their emotions. And it's the emotions that they really want heard. So I stopped listening to the man's words and tried to listen for the emotions."

    Gawande told the prisoner, "'You seem really angry and like you feel disrespected." The prisoner agreed, saying he did feel "angry and disrespected," but his "voice [had] changed" and his "eyes began to water," Gawande said. The prisoner began discussing his experiences in prison, and, "for the next hour, [Gawande] just sewed and listened, trying to hear the feelings behind [the prisoner's] words."

    Gawande said, "I didn't understand him or like him. But all it took to see his humanity—to be able to treat him—was to supply that tiny bit of openness and curiosity."

    Humanity is at the center of quality care, Gawande says

    Gawande used the story to make a broader point about how doctors must remain curious about the lived experiences of others and recognize their humanity so as to live up to "the foundational principle of medicine, going back centuries, … that all lives are of equal worth." Gawande said.

    "We in medicine do not always live up to that principle," Gawande acknowledged. However, he asserted that "without being open to [patients'] humanity, it is impossible [for doctors] to provide good care to people—to insure, for instance, that you've given them enough anesthetic before doing a procedure." To see a patient's humanity, Gawande continued, "you must put yourself in their shoes. That ... requires curiosity about others and the world beyond your boarding zone."

    According to Gawande, this advice comes "in a dangerous moment because every kind of curiosity is under attack—scientific curiosity, journalistic curiosity, artistic curiosity, cultural curiosity." Without curiosity, Gawande warned, "we lose the desire to understand—to be surprised, to listen and bear witness—we lose our humanity." Ultimately, your curiosity is "among the most important capacities that you take with you today," Gawande said. "You must guard it, for curiosity is the beginning of empathy."

    He concluded by telling the graduates, "[Y]ou will be given trust to see human beings at their most vulnerable and serve them. That trust is earned because of your values, your commitment to serving all as equals, and your openness to people's humanity. The renewal of these values is why we're all so grateful to be here—and so grateful that you will carry those values on, beyond us" (Gawande, The New Yorker, 6/2).

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