If you are a medical student or resident… You’re welcome!
There are teachers, and then there are master educators… Dr. BK Titanji is an infectious disease expert at Emory who recently posted this on Bluesky:
I emailed her to ask her for the original PDF so I could post it here with better resolution. This is not just a great tool for anyone who prescribes antibiotics, it’s a beautiful example of how to teach complex subjects.
How old are you on Mars?
It’s an interesting thought experiment… and a reminder of how time (the way we use it) is a construct.
While we’re on the topic of space, time, and the space-time continuum….
The ring around the galaxy cluster in this amazing photograph is called an “Einstein ring” (because he predicted that it would exist).
“An Einstein ring, also known as an Einstein–Chwolson ring or Chwolson ring (named for Orest Chwolson), is created when light from a galaxy or star passes by a massive object en route to the Earth….Gravitational lensing is predicted by Albert Einstein‘s theory of general relativity.[1] Instead of light from a source traveling in a straight line (in three dimensions), it is bent by the presence of a massive body, which distorts spacetime. An Einstein ring is a special case of gravitational lensing, caused by the exact alignment of the source, lens, and observer. “(Wikipedia, Einstein Ring)
“The seat you randomly chose today is the seat you’ll sit in for the rest of the term.”
That was the cold open from one of my college professors at the first class of the quarter. And he was right. About me and most of the 200 others in the lecture hall that day.
Fifth row from the back, left side of the auditorium (facing the lecturer), 4th seat from the aisle.
That’s where I sat in medical school.
Why do we pick a specific seat when we walk into a classroom, place of worship, or even a spin class (is it random or not?) … and why do we keep returning to that same seat? I’ve thought for a while that this phenomenon would be a fascinating project for an enterprising graduate student, but it turns out there have been studies done and there are three main explanations for this behavior.
Territoriality. The most powerful driver of why we choose and return to a specific seat is a very primitive one. Territoriality is not so much about claiming our rights to a specific place, but a way for a group to keep the peace. If this is my property and if you agree, we won’t fight about it.
Cognitive load. One less thing to decide means you can decrease a tiny bit of cognitive load.
Social interaction. There’s a plus to being surrounded by people you like (and who like you).
How we choose seats in an auditorium is interesting from a scientific point of view, but it’s also a powerful metaphor. We are drawn to a specific seat by a form of psychological “gravity”, which increases in strength the more times we sit there. There’s a similar form of “gravity” that draws us to our partner, our specialty choice, the city where we want to live. Most of the time this “gravity” grounds us and allows us to grow, but if and when it doesn’t, it helps to remember that you can choose to move to another seat.
“… being subject to physical gravity is mandatory, but being trapped by life gravity is optional.”
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.”
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).
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.
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.
The definition of “knowledge” in English is pretty straightforward – To “know” something means being familiar and/or aware of it in a way that lets us understand. I find it fascinating that English has only one word for “knowledge”, where other languages use multiple words to reflect the depth and nuances of the concept. “Once widespread in Germanic, the verb [to know] is now retained there only in English, where it has widespread application, covering meanings that require two or more verbs in other languages (such as German wissen, kennen, erkennen and in part können; French connaître “perceive, understand, recognize,” savoir “have a knowledge of, know how;” etymonoline
How we understand “knowledge” affects how we teach, how we learn, and how we see the world.
The philosophers of Ancient Greece saw acquiring knowledge as an important part of the human quest for wisdom. Enter episteme, techne, phronesis, gnosis, and doxa. These nuanced ways to think about knowledge and wisdom have a lot to offer us as we navigate the misinformation and philosophical chaos of our time. For those in medicine, these nuanced definitions add beautiful complexity and understanding to our work, with special inspiration for those who teach the healing arts.
Techne refers to the technical skills of a profession – the grasp of grammar for a writer, pedagogical skills for a teacher, the ability to perform specific procedures for a surgeon.
I recently read this remarkable essay by Sami Sinada in which he states: “Medical school teaches episteme. Residency builds techne. But phronesis? We assume it appears through osmosis. It doesn’t.”
The entire essay is well worth your time to read, but Dr. Sinada makes an important point – Our medical school and residency curricula have gaps when it comes to teaching practical wisdom (which is the core of doctoring). He goes on to argue that we can close that gap with five important pedagogical choices:
What strikes me about doxa is that it has no moral weight associated with it. Doxa can refer to the deep orthodoxy of thousands of years of tradition in a culture … everything from how we greet each other to what we believe… as well as culturally accepted, politically motivated lies.
Gnosis is most often associated with gnosticism, a religious and philosophical movement in the 2nd century. But I wonder if the concept of a deep inner knowing (whether or not you view that as divine) isn’t worth refurbishing for our time as an important way to “know”. Contemplation, meditation, prayer can all open spaces that defy our intellectual understanding, leading to a way of “knowing” that, in some ways, we need now more than ever.
