Diagnosis, Discernment, and Birding: Part 2

A few weeks ago one of those “scary” messages popped up on my car’s dashboard screen. 

Source

Next step – get on the internet. 

It turns out that the key thing is to look at the grille shutter to see if there is anything stuck in it. If it’s stuck open there isn’t a problem. If it’s stuck close it’s still not life (or car) threatening unless the engine overheats. Sounds straightforward… but, you have to know where to look. 

Since (of course) we were over 200 miles from home when this happened, we went to the local dealer and asked if there might be someone who could look to see if it was stuck open or closed.

“We’d have to run a full diagnostic scan first.”

“But we just need someone who knows where to look to just look.”

“We can’t do that. There aren’t any technicians available and they require the scan first.”

(At this point we decided to take our chances and assume it was open)

“You know, we are both doctors…”

He interrupted to say “So you know how important CT scans are!”

I smiled and said, “Not if all you need to do is pull out a splinter.” 

from The Making of a Diagnostic Mind by Alexandra Sifferlin

The art of diagnosis in medicine starts, very importantly, with the story. It’s actually astounding how often that will make the diagnosis. At the very least, it narrows down the possibilities. (which we call “the differential”). 

The physical exam is next, to refine the differential diagnosis and guide you in deciding which tests to order. Even if the triage team has ordered the tests first (like in a busy ER) it’s still very important to go through these steps in order, starting with a “blank slate” so you don’t fall into the trap of the many ways our brains succumb to bias (especially anchoring bias).

Designed by John Manoogian III

What makes this process, the art of diagnosis in medicine (as opposed to my car) unique is the intent. Because we always go through this process for someone else. We make a diagnosis as the first, important step in healing another human being. 

Photo by Mary Brandt

Birding is about healing ourselves

We don’t “diagnose” a bird when we go birding. There are some similarities – We look at “field marks” and listen to the songs the same way we collect data from a patient. We also create a “differential” i.e. the list of birds that fit our findings. 

But there’s is one big difference – the intent. Birding is not something we do for someone else, it’s something we do for ourselves. 

Photo by Mary Brandt (on the way to High Island via the Bolivar Flats)

There’s a reason so many people flocked (no pun intended) to parks during COVID to take up birding for the first time. It’s a focused way to be outside and experience a little bit of forest (or lake, or field) “bathing”…to connect with sounds and sights that resonate on a soul level.

Anyone who birds a favorite park over and over knows intuitively why they keep going back: It just feels good. Being in nature—pausing in it, sitting with it, discovering its wonders—brings a sense of calm and renewal.

audubon magazine

Discernment is about healing the world 

And then there’s discernment, which comes from a different, deeper intention. 

“Discernment” implies more than than just identifying a bird or making a diagnosis. We discern the difference between right and wrong, the correct path in our career, which of two important choices we should make … in other words, discernment helps us find our way in a moral or spiritual sense. Which is why discernment can be is a spiritual practice based on “noticing the movements within your heart and soul — your desires, thoughts, emotions — and identifying where they are coming from and where they are leading you.” 

Source

Compassionate action emerges from the sense of openness, connectedness, and discernment you have created.

Joan Halifax

Diagnosis, Discernment, and Birding: Part 1

This weekend I went to the beach (which is what we say in Texas, instead of “the shore”). Specifically, we went to North Padre Island so I could give a talk at the Texas Medical Association meeting, but we added a couple of days onto the trip so we could bird. 

And boy did we “bird”… 

I was introduced to birding by my parents as a child, but my spouse has become immersed in this world and has been a welcome guide and companion as I dipped my toes back into the waters (a pretty good metaphor since a lot of what we saw on this trip were shore birds).

If you are someone who has a high pressure job (like all the healers I know) and very little time (ditto), this may seem like a crazy suggestion… but there are three good reasons you should learn to bird (and then do it):

It’s healing.

What incredible beauty is around us and what a great way birding is to be present to it.

    Photo by Mary Brandt

    It erases differences.

    I am absolutely certain that the people around us had many contradictory views of politics, religions, and all the other points of friction in our society. But none of that mattered. We shared the paths, showed each other birds hidden in the shrubs, and grinned together (a lot).

    Photo by Mary Brandt

    It reminds me of making a diagnosis.

    Identifying a bird is a lot like making a diagnosis in medicine, except when it isn’t. I’m pondering the difference between diagnosis, identification, and discernment (more to follow on that after I think a bit more – i.e. in Part 2 of this post next week).

    Photo by Mary Brandt

    To make a “diagnosis” as a birder you use field marks, which are a lot like symptoms in medicine – the things you notice and consider before you make a diagnosis. In the case of the bird in the photo above… a bright blue bill with a black tip, a dark eye with a white ring, a slightly brownish long neck, a bluish tint to the head and body, a whitish tuft on the back of the high neck (we would say postero-superior in medicine), and the beautiful fluffy feathers hanging down from the back.

    All of which adds up to a Tricolor heron in breeding plumage.

    You don’t have to become a “bird nerd” (an accepted and even appreciated term in the community) to bird, but it’s worth learning to pay even a little attention to the birds around us, because it will get you outside, provide you with the dopamine surge you get with any hide and seek game (when you find the treasure), and surprise you with joy. 

    Here’s how to get started

    • Download Merlin ID
    • Get a pair of binoculars
    • Go outside
    • Listen, look up, and notice

      Merlin ID 

      It’s hard to overstate how incredible this app is… even if you only use it every once in a while (and even if you have no plans to become a birder), you need to have this on your phone.

      Binoculars 

      Borrow a pair, find a used pair, start with a cheaper pair, but be prepared to upgrade – you’ll need to have a decent pair of binoculars at some point. 

      Based on this review I ended up buying the Athlon Midas 8×24 binoculars, which I love. This particular set of binoculars seems to go on sale fairly regularly for WAY less than their list price, so shop around if these are the ones you decide to get. 


      Photo by Mary Brandt

      “may my heart always be open to little birds who are the secret to living” 

      e. e. cummings