I was recently at a meeting speaking with one of my colleagues, a family physician with a practice much different than my own, and we were discussing the challenges of making effective consultations. She commented, “it’s hard to find a curious neurologist to whom I can send my patients.” As our conversation unfolded, we agreed that this sentiment could be applied to so many of our consultations. I suspect that you’ve had similar experiences in your practice. If you reflect on the most helpful and collegial clinical relationships that you have, I suspect that you will notice certain unifying characteristics. After you have invested diagnostic effort to complete a thorough workup before making a referral, you expect that the physician receiving the referral will engage the patient and offer recommendations based on experience and expertise. It is disappointing when the patient returns to you without a clear diagnosis, useful " next steps," or similarly helpful recommendations.
Before you think that this is a story about family physicians expressing some latent sense of superiority over our specialty colleagues, allow me to bring this idea closer to home. Do we interact with our patients with real curiosity? One of our favorite residency faculty physicians was known for his relentless pursuit of an accurate diagnosis, and was often heard saying things like, “don’t ignore what
you can’t explain,” “when you hear hoofbeats, don’t look for zebras,” or “sometimes one diagnosis doesn’t explain all of the patient’s symptoms.” Another mentor, a family physician, would remark “even crazy patients have real diseases,” if we were too quick to dismiss concerning elements of a patient’s history or exam by attributing them to known mental health diagnoses. It was not a harsh statement, but a compassionate one; it reminded us to dig deeper, ask more questions, and not jump to easy conclusions.
These notions underscore curiosity as a key diagnostic motivation, or, more broadly, a relational motivation. Are we taking a history in order to populate the requisite number of bullet points in our EHR, or are we interacting with patients with a genuine interest in learning their story and understanding how their symptoms arise from the background of their unique situation? I suspect that many of the challenges of integrating the best principles of the diversity and inclusion movement would
be more easily overcome if we approached others, particularly those with backgrounds and perspectives different from our own, with a mindset of curiosity and humility. Moreover, our patients are far better able to receive our counsel, implement our recommendations, and live better lives when they accurately perceive that our interest in them goes beyond data collection to something more meaningful and transactional. Trust develops, and both parties are richer for it.
There is a strong historical argument for the virtue of curiosity. A physician in the time of the Roman Empire, Luke, lauded the people in the Macedonian city of Berea for their curiosity and diligence because they read the supporting documents of the day when considering new ideas presented by traveling scholars. Galileo, a catholic who earned disfavor from the church for postulating that the world was round, not flat, was fascinated by the beauty of creation and sought to utilize science and inquiry to better understand the unknown. In fact, many of the great scientists, explorers, and physicians throughout history were motivated by a desire to understand the unknown, map the uncharted, or cure the undiagnosed disease.
In spite of a vast amount of knowledge more readily available to us than ever before in history, or perhaps because of it, our culture seems to be losing its curiosity. This goes far beyond medicine. We exchange meaningful conversation for emojis and text gibberish. Instead of reading a good book or classic literary work, we watch simplified adaptations and videos. Principled and articulate debate about meaningful subjects is reduced to slogans, insults, and shouting. Why do we settle for something so worthless when great value exists? Where is the invitation to learn, to grow, to develop, to inspire?
All of that seems rather lofty, perhaps, compared to diabetes care and well child visits. We are, after all, surrounded by patients, staff, colleagues, and others with seemingly mundane stories. Our own stories may seem equally ordinary. However, I contend that each human has profound value. If that is indeed true, then ought we not have an interest in learning more about one another? As we learn each other’s
stories, as we ask questions (Why? Why not? How? With whom?) and listen to the answers, we fuel more curiosity and more understanding.
Not convinced about the value of curiosity? Research on the benefits of curiosity found that curiosity is one of the five strengths most reliably linked to satisfaction with life. Curiosity is also associated with happiness, health, longevity, and positive social relationships. One of the many paradoxes in life that I repeatedly encounter while writing these articles is how the character traits and virtues which are good
for the practice of medicine generalize to being good for the physician and for others.
A conversation about some of these topics may be beyond the scope of this article, but I would welcome a discussion over coffee or by email. Please contact me at president@wafp.org if you are so inclined.
