8.2 - Curiosity

[Intro music]

Hi and welcome to the Hippocratic Society Podcast. This podcast is a project of the Hippocratic Society.

In the podcast we aim to reflect on deeper questions in medicine, all with the aim of rediscovering the ideals that brought us to medicine in the first place in order to better serve our patients and colleagues.

Unknown

Thank you for joining us and we look forward to engaging with you through this podcast.

Michael Egan

Hi and welcome back.

Michael Egan

I'm joined again by Dr. John Rhee.

Michael Egan

Today we're going to talk about curiosity and this episode follows on our episode with Dr. Carrie Brenner titled Therapeutic Presence.

Michael Egan

And so in the spirit of curiosity, John,

Michael Egan

tell us about what's going on in your life.

John Rhee

Sure. Thanks, Michael.

John Rhee

Yeah, I guess the major thing that's happened recently is I was on a week of inpatient service for neuro oncology. And yeah, in a certain sense it was a pretty intense week.

John Rhee

There were a couple of young patients admitted with including new diagnoses of high-grade glioma.

John Rhee

And I think whenever I'm on service, it always makes me reflect on the fact that I both really love clinical work and then when I come off the service, also reflect on how challenging clinical work really is from both the emotional standpoint but also the physical standpoint.

John Rhee

Just wasn't sleeping well because of pagers going off overnight, things like that.

John Rhee

Yet the thing that gives me a lot of consolation is, especially this time around, got a lot of pages on the weekend,

John Rhee

was woken up by a Quest Lab page at 2am with a critical lab value that,

John Rhee

you know, for a lab drawn three days ago.

John Rhee

So like not very helpful at 2am and then I was like,

John Rhee

you know, all angry about it and couldn't sleep for an hour because I was like, why did they call me at 2am?

John Rhee

But then still, despite all of that,

John Rhee

ending the week being like, wow,

John Rhee

I wouldn't trade doing this for anything else that I do really love the practice of medicine.

John Rhee

And that always makes me also feel like,

John Rhee

yeah, this is exactly what I want to be doing, what I should be doing. And despite being physically tired, also have deep sense of fulfillment like that. I did really good work at the end of each day.

Michael Egan

That's beautiful. Thank you for sharing. Very inspirational, especially for, well, actually for all of our listeners, hopefully.

Michael Egan

And yeah, in the spirit of curiosity, thanks for asking about me. Anyway, we can start so talking about curiosity, John,

Michael Egan

before we even get there. What are some prerequisites for curiosity? What are some things that in ourselves or just attitudes that we have or dispositions that we should bring to the table to be curious.

John Rhee

Yeah,

John Rhee

as always, I think about this in the context of clinical care and also just with some introspection,

John Rhee

we often have this tendency where when somebody else is speaking,

John Rhee

we are immediately making either judgments or formulating responses to what they're saying. Right. And in a certain sense, when we're doing that too much, we may actually miss what the other person is saying.

John Rhee

I think this happens a lot in clinical medicine where when we're trying to get a history from a patient, we have a clear objective. And so as soon as the patient says what we want to hear, we kind of push them towards another question.

John Rhee

And I think that this happens also in very complex conversations, including things like goals of care, which, as a palliative care doctor, I do a lot,

John Rhee

where we go in with a sense of wanting to get a certain answer from a patient.

John Rhee

And when we don't have judgments about whether that person understood or not.

John Rhee

And I think that these are just important concepts to reflect on, because there are a few things that we could think about that may be missing. Right. One is just a sense of presence.

John Rhee

So that ability to slow down and attend to the person in front of us,

John Rhee

to really try to be present to that particular person in their fullness.

John Rhee

I think another is the sense of security,

John Rhee

where we don't default to trying to get what we want, or even a defensive posture,

John Rhee

but being open to what that person has to say in front of us. And then lastly, what I would say is a genuine sense of understanding.

John Rhee

And when I think about understanding, I think that the virtue that's maybe most closely related to understanding is love,

John Rhee

because love is expressed, I think, most clearly through understanding.

John Rhee

And any type of conflict with another person, I think, usually depends on when we are unable to understand where they're coming from,

John Rhee

or perhaps unwilling to understand where they're coming from.

John Rhee

And so those are the three things that I would say are truly important in this approach of curiosity to the patient.

Michael Egan

Makes a lot of sense, John. And I love that last point about understanding. And it reminds me of a quote I heard from Dr. Kevin Majors. Maybe he was quoting somebody else, but I think it was that curiosity is love seeking understanding,

Michael Egan

which I love as an idea. It's almost loving someone with all your energy, but in the intellect specifically, and trying to understand them completely so that you can love them more with your will.

Michael Egan

And so now that we have these prerequisites,

Michael Egan

you have to be present. You have to have sort of sense of security, not defensive or in threat mode as. As they say, and you have to have some understanding.

Michael Egan

What does it look like to be curious in that clinical encounter where you're interviewing a patient and you want to get to some sort of diagnosis or you know exactly what they're going to say about their history because you've heard it 50 times before.

Michael Egan

What does it look like to be curious there?

John Rhee

Yeah.

John Rhee

Here I want to just separate out.

John Rhee

Maybe we could talk a little bit about etymology or where there is this idea of curiosity, or the word is curiosity in English. But what we're talking about when we talk about curiosity is actually not curiositas.

John Rhee

So for those who love Latin out there.

John Rhee

So curiositas would be actually a disordered curiosity, which is like excessive, prideful, vain or misdirected. We could think about this type of curiosity when we're perhaps trying to overhear gossip or trying to push people into gossiping about somebody.

John Rhee

Right. Or something.

John Rhee

But rather, what we're talking about is studiositas.

John Rhee

So in English, we don't really have the same translation, but the idea of studiositas is a virtuous curiosity in the sense that it's rightly ordered and oriented towards an end that is good.

John Rhee

And in this case, the end that is good is an orientation towards trying to both love through this idea of understanding a patient,

John Rhee

as well as to try to uncover or understand what is the true or the truth behind what we're talking about.

John Rhee

And so studiositas is different than curiositas because it involves this genuine desire to know the truth. And it also has another virtue contained within it, which is temperance. Right.

John Rhee

This temperament, restraint and that desire.

John Rhee

And it has that telos or that proper end where we're trying to either love the other,

John Rhee

have reverence for that person,

John Rhee

or to try to gain additional wisdom rather than just some type of excitement or some type of unrestrained curiosity.

Michael Egan

Great. So, yeah, I like that distinction a lot between curiositas and studiositas. I think curiosity is sort of a nebulous term that doesn't have such a clear definition in a lot of people.

Michael Egan

People's minds, I think. And there. That actually reminds me, I wanted to point out an article written by one of our doctors in the Hippocratic Society named Ben Fresh, who I.

Michael Egan

I believe the article is called Studio Sitas in Medical Education.

Michael Egan

And he quotes another writer, Paul Griffith,

Michael Egan

about curiositas, who calls it an appetite for the ownership of new knowledge, whose method is enclosure by sequestration.

Michael Egan

I love that emphasis on ownership and sequestration because it's almost like you are desiring not just the knowledge itself, but you are desiring yourself through the knowledge that you want the ownership of it.

Michael Egan

And you can see how that sort of gets very ravaging and not virtuous, not temperate at all. But I do want to make one other or ask one other point about the virtuous nature of curiosity.

Michael Egan

So if you have curiositas going too far, with studiositas, and in virtues, a lot of times, following the tradition of Aristotle, we talk about virtues within a mean.

Michael Egan

And so I guess the excess could be curiositas, where you're going too far.

Michael Egan

And the deficiency would that just be not seeking enough, not wanting to know enough?

John Rhee

Yeah,

John Rhee

you know, I think that in a certain sense in medicine, perhaps where we are often lacking is in that deficiency.

John Rhee

The other day I was consulted as a palliative care physician on a patient who all the clinicians felt like her husband should be dnr, dni,

John Rhee

but she wanted him to stay full code.

John Rhee

And there was this what was felt like an inability to overcome this disagreement about what should be done for her husband.

John Rhee

And she was basically answering in a way that was very oftentimes rude, but also disagreeable to any member of the medical team. That reached out, understandably, because she was frustrated about having the same question asked of her again and again.

John Rhee

And so I decided, entering into this situation, to not go in with trying to get a different code status out of her, but rather to try to understand where she was coming from.

John Rhee

So I took this approach of Studio CTEs and I asked her just the question of tell me more about what's going through your mind, what's going through your heart when you hear about this code status discussion.

John Rhee

And so she told me about the fact that she's religious, as is her husband, and that she believes in miracles and that she thinks that a miracle could happen, and so that she didn't want to reverse his code status for that reason.

John Rhee

And I think that this is where the perhaps deficiency lies in terms of not asking enough,

John Rhee

because we could have an immediate judgment there and be like, a miracle is not going to happen. And so this is unreasonable, and I hear this a lot, actually, among medical staff where they might say, just arrive at preconceived judgment of some miracle being just something that doesn't make sense and therefore we should not explore it more.

John Rhee

Rather, I followed it up with the question of,

John Rhee

sounds like you've experienced miracles before. Can you tell me about some of them?

John Rhee

And she told me about stories in her personal life where she felt that she had witnessed miracles.

John Rhee

And this was actually the main point that got us to eventually to the discussion of how. And I pushed her a little bit further that how that's really beautiful. And that I thanked her for sharing those miracles, the stories of miracles with me,

John Rhee

and that it sounds like we can both live in a world where we hope for miracles and at the same time to recognize when there might be something happening in front of us that may also be a part of.

John Rhee

Of this providence or plan that we don't necessarily have control over.

John Rhee

And it was actually only in that context that she agreed to that and said that she would recognize when her husband is nearing death and that she, at that point then would change his code status.

John Rhee

And so we actually reached a place where we reached an understanding that was true about understanding, where it wasn't that she was misunderstanding people's questions, but she didn't feel her husband was at the end.

John Rhee

End of life.

John Rhee

And in a certain sense, I actually agreed with that assessment. He wasn't. I think it's also understandable that the medical team wanted to have a backup plan if something emergent were to happen in the hospital,

John Rhee

but that we also were able to discuss that in the case where something happened emergently and something was going to be deemed truly irreversible,

John Rhee

then we may not be able to do anything. And she seemed, in that moment, she acknowledged that. And so I think that that's where a lot of times we have a preconceived judgment of something that a patient's saying, and we don't actually explore enough of true understanding of where the other person is coming from to try to understand,

John Rhee

like, the way that they think,

John Rhee

the way that they hope their story really, of how they've arrived at that conclusion.

John Rhee

And I think only when another person also feels truly understood or heard is when they're also able to give a little in terms of a basis or foundation of trust in which then they could be working or you could be working with them on.

Michael Egan

It's a very beautiful story, John. And I think that speaking speaks numbers to curiosity, why it's so important,

Michael Egan

how it works out in clinical practice.

Michael Egan

And I think you can see that the lack of development of the virtue of curiosity in medical training could lead to both the deficiency, as you were just talking about in this case, with people not wondering enough really about this patient,

Michael Egan

but also it can almost be a product of the excess of curiosity where not having that right view of knowledge and not pursuing it in the right way leads to this deficiency.

Michael Egan

Even if before is practice in the excess. And I bring that point up just because Ben Frush's argument is that in medical education especially,

Michael Egan

that the vice of curiositas is actually more prevalent where people are hungering for knowledge in an intemperate way, basically just trying to get it for themselves. They can pass the USMLEs, then they get to residency, and then they don't have this virtue of studiositas, which ends up in situations like this.

Michael Egan

But, yeah, I think that that was a beautiful story, and it speaks numbers to why we need curiosity.

Michael Egan

And so with that in mind,

Michael Egan

could you give us some tips on how we can practice curiosity, the virtue in clinical practice, and just in our daily life?

John Rhee

Sure.

John Rhee

I think going back to the example that I gave,

John Rhee

there is an importance of really having this ability to reflect on self,

John Rhee

that when we feel ourself arriving at immediate judgments in the beginning of a conversation with a patient, to really pull back and be like, how can I understand this person more fully?

John Rhee

Which is really a question about how can I love this person more?

John Rhee

And if we come at it from that angle, then I think of understanding, then I think we would ask questions differently. We would ask about questions that are directed in a way in which we are trying to deepen the relationship with the other,

John Rhee

so truly trying to understand their life story,

John Rhee

trying to understand who they are,

John Rhee

and so taking a little bit of a detour. That actually helps in the longer run of when we understand, like, why a person makes decisions that they make,

John Rhee

because that tells us about who they are and the experiences that led them there.

John Rhee

Those questions are really, ultimately, I think, what helps us to be able to lead with the sense of curiosity.

John Rhee

And so in palliative care, we often talk about this. But whenever you want to hear more, just say, tell me more about that.

John Rhee

Or to deepen the bond by hearing people's experiences, asking them, what was that like for you?

John Rhee

Or to just even repeat back to them what I mentioned. It sounds like you've experienced miracles before.

John Rhee

Tell me more about that.

John Rhee

Or to even just ask them about what they're worried about, what they're hopeful for,

John Rhee

and allow that to guide the conversation or just getting to, again, know them as a person.

John Rhee

I think another thing that we can always be working on is by working on the sense of wonder.

John Rhee

And so even in our personal lives, if we were to approach things and relationships and conversations with this sense of wonder,

John Rhee

perhaps especially in the relationships that are important to us,

John Rhee

because the relationships that are important to us oftentimes are also the ones that we may be getting into conflict more often. Right.

John Rhee

How can we really delve into the sense of wonder at this person?

John Rhee

And we could often exercise that through, I think also the humanities, because I think the humanities provides this open endedness to bigger questions through things like art, music, poetry and the reflection of beauty.

John Rhee

And then I would say lastly, embracing the sense of silence. Because it is only when we're able to find silence within ourselves that we're able to then find that brief moment of silence in a moment where we may be having this judgment of another person or this quick judgment of what we think is the right next step,

John Rhee

to be able to have that moment of silence for self reflection, to be able to take a step back and be like, okay, how can I try to love and understand this person more?

Michael Egan

Great, thank you. Those seem like very helpful tips. And just before we go,

Michael Egan

what is one thing that we can do to avoid curiositas or the vice of curiosity?

Michael Egan

Yeah.

John Rhee

One of the things that we always come back to in the Hippocratic Society is just this idea of trying to identify the good of each virtue.

John Rhee

And so in these different situations,

John Rhee

if we are finding ourselves trying to just get more information for the pure sake of curiosity itself. Right. This idea of intemperate curiosity or the saying of curiosity killed the cat.

John Rhee

Right.

John Rhee

And rather to try to anchor in the service of what is good, the true and the beautiful,

John Rhee

and to try to understand like what is the good that I'm trying to achieve or to reach when I'm practicing the sense of curiosity.

Michael Egan

Great.

Michael Egan

So sort of reflection interiorly, very briefly about what we're actually looking for and our motives. That sounds wonderful and very practical.

Michael Egan

Thank you, John. This was a great reflection on curiosity.