by Ron Epstein, MD
“The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.” -F Scott Fitzgerald
Fitzgerald’s quote reminds us that intelligence is fickle. We think we know something, but perhaps we only know part of that something, or perhaps only one way of knowing that something.
There is an apocryphal story about Neils Bohr, the scientist who discovered quantum theory, an insight into the universe that was neither intuitive nor conventional. In his university years, the final examination in a physics course included a question asking students to determine the height of a building using a barometer. Bohr was aware that the professor was seeking a physics-based answer, making a calculation based on the difference in air pressure at the top and bottom of the building.
Instead, though, Bohr answered that you could go to the top of the building, tie a string to the barometer, and lower it to the ground – and then add the length of the string to the length of the barometer. This enraged his professor, and he gave Bohr a failing grade. Bohr protested, proposing several other non-conventional ways, including throwing the barometer off the roof and timing how long it took to hit the ground. He was more interested in possibility than reaffirming conventional thinking. Bohr once said, “The opposite of a correct statement is a false statement. But the opposite of a profound truth may well be another profound truth.” Light is a wave; light is a particle. Of course, some profound truths receive a warmer reception than others.
I carry these insights into my life as a clinician and researcher. There is more than one way to make sense of a situation, and the thornier the situation, the more important it is to be able to set aside preconceived models of the world as well as judgment.
As a primary care physician, many of my patients had diabetes, and many of them never achieved what has been termed “good control.” There was a non-flattering word to describe such patients, “non-compliant,” with the implication that they were intellectually, behaviorally, or morally deficient. I have learned to avoid the term, not merely because it is judgmental, and not because it doesn’t contain any grain of truth. Indeed, many patients don’t take their medications as prescribed, and many do not adhere to a prescribed diet. It is also true that most patients are trying as hard as they can. Locking myself into one way of thinking, and applying judgments prematurely limits my thinking and my ability to help each patient. Alternative possibilities abound. The patient might not be able to afford the medication. They might have side effects that they feel ashamed to report. They might not have the skills or means to cook separate meals for different family members. Their diabetes might be more resistant to the medications than I had thought. I may have used too much medical jargon, and the patient didn’t feel empowered to ask a question for fear of appearing dumb. Or, perhaps they made a values-based decision that enjoying life now was more important than a few additional months or years of survival.
“Beginner’s mind” refers to not letting one’s expertise or experience limit the ways we experience the world. Letting go of expertise is not always easy. But it is often liberating. It is an invitation to see the novelty in the familiar, to discover disruptive islands of joy. In 35 years of primary care practice, I knew many of my patients for decades. Some presented the same concerns and symptoms for years. With each upcoming visit, though, I have a choice – to expect the visit to be just like the last one, or to expect that there will be one thing, perhaps a very small thing, that will help me see the patient’s situation from a new perspective, and perhaps help them in a new way.
Perhaps more importantly, adopting a beginner’s mind has been one of the keys to finding joy in practice and addressing the ever-looming threat of burnout. It liberates me to be more flexible, caring, and effective as a physician.