Have you heard the admonishment to live your life with a cool head and a warm heart? My daughter was just hooded with an Honours in Economics, and is off to do her MBA, much too far away for my liking. Yes, she’ll probably read this. I’m sure she knows I’d rather have her upstairs, in her room 6 feet down the hall. Her commencement ceremony just dripped with this sentiment.
Her favourite professor was on stage. She and her boyfriend made a point of speaking with him afterwards. This economist was someone that had clearly made an impact … I don’t think he actually addressed the audience, but more than one person talked about him. He apparently would wax on about the importance of having, “Cool head and a warm heart…” when in class.
Engage the world with a cool head and a warm heart… What words of advice.
Economics. Bean counters. Policy. Rules. Black and red ink. Statistics. Numbers. Where is the warm heart in that? Economics is a study, and a tool. It’s how that tool is used, and where.
The keynote address was about getting away from cold statistics. Numbers, and things measurable, were depicted as consuming society, and overtaking “softer” very human studies such as art, music and literature. Bold broad thinking companies were trying to open the door to the softer pursuits, interestingly describing the skills needed to engage them as being “non – cognitive.” As an aside the speaker looked up and queried, “non-cognitive?” Agreed!
Medicine is practised one on one, physician and patient. Nowadays, there is a computer monitor in between. In 1986, when I graduated, we were strictly taught to have no form of obstruction between ourselves and the patient. That meant anything, a crossed leg, a chart on a lap, and certainly a desk. Sit behind a desk to interview a patient? Want to flunk?
When our clinic first brought computers into the exam rooms, we had laptops. I carefully put mine to one side while I interviewed, but soon recognized I simply couldn’t do it. This wasn’t the paper record. Things were slower, more involved, and I did want to occasionally get home for dinner. So I put it on my lap, and the taboo was shattered.
Still, when I want to reach a patient, I’m out from behind that stupid machine, and looking right at them, leaning forward, nothing in between. Know what?
It works. Too bad we can’t do it all the time. EMR. The good, and the bad.
MDAngst, the website and blog, exists because I found that I was practising medicine differently during my M.Ed, and have continued on this new path. The blog keeps me thinking about the material, and describes my journey. I think about what is occurring in clinic very differently. The biggest change is probably the analytical one, where I try to step back and really see what is going on.
I count beans. I use that computer, and do spreadsheets, looking at my decision making, the factors involved, and outcomes.
Have I lost my warm heart? Not by a long shot. Approaching medicine with an action research spin does not chill the blood. Analysis itself does not force you into a lab coat, and put your patient on a microscope slide, pinned under the stage clips.
A cool head and a warm heart may just be the most essential qualities of a physician. I would want the ERP running my arrest to have a cool head, to remember and be able to apply the emergency protocols. I’d also want him to be able to talk to me, to see that I was afraid, to help me, and help my family understand. I would want my psychiatrist to be able to diagnose me, to prescribe the right medicine, but also to be really with me as I vented all the poison. My family doctor to not just fill out the template, but to look at me, and smile, and maybe even joke. I’d want my doctor to care. And to think.
Yes, computers, numbers, and quantitative large RCTs may be new, best thing. They help show us where we’ve been, and where we’re going. They’re powerful enough to tear to shreds treatments based on logic, and extrapolations of basic science (come to think of it, that’s medicine as it used to be done). But they’re anonymous, big, impersonal robots, that the rank and file family doc has no part in. We sit on the sidelines, hear about the big ongoing trials, and read the journals. The quantitative study has made the physician much more of a cool headed natural scientist. But we’re more than that. We need to be that warm hearted physician, that health care provider that cares.
Can a slightly different scientific approach help that? I suggest looking at the qualitative study, that against which we’ve all been trained a bias. Quantitative studies are just not geared to look at real, fibrous, tactile analysis of a person, or a small group of people. They just can’t get the same kind of gritty, intimate detail. Studies like these are the backbone of research for a teacher. Isn’t that what we do? Teach? Qualitative studies are the warm heart of the analytical approach to teaching, to science, and can be one of the main building blocks in the action research approach to medicine.
With a cool head and a warm heart. That’s how we approach our patients. That’s how we should approach our analysis. Quantitative, and qualitative.