Definitions
- “An eager wish to know or learn about something”
What is Curiosity?
- Curiosity simply is not necessarily a virtue.
- Philosophers such as Thomas Aquinas differentiated between bad curiosity, “curiositas”, and good curiosity, “studiositas,” which is the proper direction and application of the natural desire to know.
- Studiositas is the mean between the absence of seeking knowledge and unrestrained curiositas. It involves “a certain keenness of interest in seeking knowledge of things” as well as a temperate restraint of the desire to know.
Why should we practice the virtue of Curiosity?
- Curiosity towards the patient has multiple benefits: fosters more personal relationships and increases empathy, which in turn positively affects the patient’s healing process, is an expression of compassion, and can bring new relevant information to light.
- Curiosity combats “mechanical care.”
- Curiosity could prevent burnout and improve physicians' happiness and satisfaction.
Aristotle’s Doctrine of the Mean
Aristotle’s Doctrine of the Mean emphasizes balance as the essence of virtue, symbolized here by a mountain peak with a flag representing the ideal midpoint. Each virtue lies between two opposing vices—deficiency depicted on the left, and excess, on the right slope. For example, courage is the balance between cowardice (deficiency) and recklessness (excess). In a medical context, this principle guides healthcare professionals to strive for the peak of ethical behavior, avoiding the pitfalls of extremes to ensure thoughtful and compassionate care.
Case Studies
You are a palliative care physician. It is the early afternoon, and you are getting some of your clinical notes and family meeting notes completed from the morning. You get a page that reads, “Palliative care consult for GOC for a family that doesn’t ‘get it’”.
You call the resident back to get some context on the consult.
“Thanks so much for returning my page. This is for RK, a 23 year old man who has osteosarcoma and has now gone through multiple lines of therapy, coming in with worsening pain and found to have further progression of disease. We were talking to his parents at bedside yesterday, who, by the way, have been ‘difficult’, and had a conversation with them about making him DNR/DNI. And they responded by saying that they ‘believe in miracles’ and that they want to keep him full code. We were hoping you could help with conversations and goals of care for these parents who don’t really ‘get it’.
You reply, “Could you tell me a bit more about the specific conversation you had regarding code status and their belief in miracles?”
The resident replies, “Well, it’s clear that RK is dying and not responding to therapy. So, we had a real discussion with him and his parents about it and suggested hospice. In that context, we said that it would make sense to make him DNR/DNI. And that’s when they said they were religious and believed in miracles.”
You thank the resident for the context and go over to see the parents. As you enter the room, you see that the parents are sitting at bedside holding RK’s hand and talking softly to him. You introduce yourself as the palliative care specialist and what palliative care is. You notice that they stiffen up to this. So you decide to start off with just getting to know RK.
“Tell me a bit about RK,” you start off. After hearing a bit about his life, RK’s mom brings up that, “I believe in miracles, we’ll get through this.”
To this, you reply, “It sounds like you’ve experienced miracles before. Tell me about them.”
To which, the mother turns to you in a more excited way and tells a story about how they were told that the initial diagnosis was grave, that the osteosarcoma had already wide metastasized, and that he had been hospitalized with a grave PE soon after, and was intubated, and that they were told multiple times that RK was “not going to make it.” But he did, and he was able to live another year, responding at times to some therapies and not to others.
You respond, “It sounds like you’ve already experienced a lot of miracles.”
To which RK’s mom replies, “I know that this cancer isn’t going away. And I recognize this could be the end. But I also think that not at least giving him a trial of intubation for a possible reversible cause like when he had the pulmonary embolism, wouldn’t make sense.”
Discussion Questions
- If the physician had not asked more questions of the resident, would that impact the following interaction with the patient’s family?
- If the physician had not asked questions of the family, how would that impact the palliative care consultation? Would the physician have been able to be as effective as possible? Would the patient’s family feel cared for?
- How did the palliative care physician’s questions to the patient's family help? Did they bring out new information that otherwise might not have come to light? Did they help in the patient-physician relationship? If yes, how? Specify both how it affects the physician himself/herself and how it affects the patient/family.
- What is the reason/motive behind each of the physician's questions? Are they good motives?
- What are some good and bad motives generally for asking questions?
- Does going out of one’s way to be curious and ask questions make the job easier or harder?
- Notice that in this clinical case, the main character speaks less than the other characters, and most of the things he/she said were questions. Did this give you the impression that the physician was clueless, or that he/she was good at what they do and used curiosity as a strength? How does this make you feel about any reservations you have about asking questions because you are self-conscious or do not want to complicate things?
- If the physician had a habit of mechanical care and lacked curiosity, how would that affect him/her over a long period of time?
How do we foster Curiosity?
- Ask questions.
- Listen.
- Be on the lookout for “mechanical care.”
- Curiosity is contagious: try to express inquisitiveness to foster it among all those you are with.