curiosity as a clinical virtue

A few months ago, I watched the first season of Ted Lasso. It’s a delightful show – hilarious, heartwarming at times, with an endearing title character. One scene really got me thinking (key moment starts at 2:16).

NSFW Language. The key moment starts at 2:16.

“Be curious, not judgmental”

Walt Whitman

While this may not seem particularly illuminating to some, it resonated with me as someone who has had a tendency to leap to judgment. Ever since, I’ve been reflecting on curiosity as a key component of fulfilling medical practice. A quick Google search reveals I am far from alone in this sentiment, and others have written beautifully on the topic.

Let’s consider how this may integrate into zentensivist practice, from multiple angles.

The Patient

Curiosity changes the way we interact with patients. It’s easier to appreciate the nuances of their acute and chronic disease processes, a factor that is particularly important in times when it seems like every patient in the ICU has a “standard COVID ARDS” presentation. It also drives us to see the patient and the disease as separate entities – perhaps motivating us to get to know our patients, especially important in the oft dehumanizing environment of the ICU.

A brilliant example of cultivating these habits is this 18 min TEDx talk by Erika Schillinger. She describes a program in which medical students partner with patients to understand their lives in the context of illness and seeking medical care.

To highlight the problems we face without curiosity, think of how many times you’ve heard phrases like “oh it’s another DKA, just a CHF exacerbation, etc.” It’s clear how this may lead to incomplete patient evaluations, perhaps missing key details.

“You see, but you do not observe!”

Sir Arthur Conan Doyle

Anecdotally, this mindset seems to seep into some trainees after one to two years of postgraduate training (it certainly did for me), though it can be pervasive throughout the ranks and across health professions. I suspect some of it may come from relatively inflated confidence (as in the Dunning-Kruger effect), though there is likely a significant contribution from the “hidden curriculum”. As Peter Richards wrote, “the greatest challenge is to inspire students to curiosity, to fan the flames of their own enthusiasm and the empathy which goes with it.” Our task is to become the role models which can inspire them.

The Practitioner

Curiosity may also have implications for career satisfaction. If the common patient problems you encounter bring about the feeling of “ugh, another [X]”, this is a call to appreciate the peculiarities of cases, recognizing what is unusual, what may require individualized care, and what you may have never seen before! In this way, cultivating curiosity can lead to restoring the wonder you may have lost about your particular field, or medicine as a whole. It may drive you to ask new questions and acquire new knowledge and skills. Or even listen to excellent podcasts run by Curious Clinicians!

Implications for clinician-scientists are obvious, as curiosity is the foundation for any interesting research question. From a leadership perspective, think how infectious this attitude may be for the rest of your team!

Another aspect that is well-highlighted in the Ted Lasso clip is his understanding that others may (currently) lack curiosity, rather than considering them fundamentally flawed. When we see colleagues who are dissatisfied or disengaged, there can be a tendency to cast judgment. It is possible they have lost curiosity in their work in the face of the many stressors in practice – but we can help them try to find it. Finally, if we remain curious about them as people, we may be able to identify ways in which they are struggling and how they may need support on a deeper level.

Avoid Pitfalls by Integrating Curiosity & Zentensivism

One could imagine that curiosity run amok could lead to counterproductive behaviors. Any of us who trained in internal medicine know how easy it is to go down a diagnostic rabbit hole, exhaustively considering differential diagnoses and ordering a multitude of tests. This practice clearly is misaligned with zentensivism. Balancing curiosity with zentensivism maintains our focus on the most essential aspects of care evidence-based practices and Bayesian reasoning. Sure, hypertension can be caused by pheochromocytoma, but we shouldn’t look for it in most cases. Taking a “leave no stone unturned” approach to diagnostics betrays understanding of base rate statistics, and importantly, may lead to iatrogenic harm.

How does curiosity, in turn, balance zentensivism? A common concern I hear from skeptics of zentensivist practice is that they are afraid that minimalism may lead to nihilism. While this is far from the heart of zentensivism, one could see how careless passivity could lead to harm. Curiosity ensures that the latter part of “minimally invasive, maximally attentive” is maintained. It brings us back to the bedside to engage with the patient and assess the effects of our interventions.

How do I do it?

Maintaining curiosity is more a developed skill than innate attribute. It requires cultivation just like any other skill, and may be a key component to maintaining a healthy relationship with medicine. As Justin Morgenstern writes, “curiosity is not static”. In his excellent article on the topic, he describes intentional practices such as setting phone reminders to “be curious”, and intentionally delving deeply into a new topic at least once a week.

I have found the moments where my curiosity has waned to be the perfect opportunities for renewal. When I feel tired, overwhelmed, or somewhat bored, it is a call to intentionally seek out opportunities for curiosity in that moment.

What has worked for you?

-MTS

Notes:

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