Raymond Chandler remarked, "There is nobody less curious than a doctor." When I read that I thought, "No, just the opposite." But over the years, I think I'm beginning to appreciate what he means.
When a physician, has forty patients scheduled to be seen in eight hours, and he is confronted by a person he thinks is in the exam room because she has a cough, but it turns out she is actually short of breath and has just got back from a 20 hour airplane ride, and she has not just a cough but "dyspnea" the sense of air hunger, then the physician begins to regret asking more questions than the minimum. Now he is faced not with a 10 minute patient with a viral respiratory infection, but a possible pulmonary embolus (lung clot) which gets to be a 40 minute patient. He has, in the immortal words of The Wire's Bunk complicated and burdened his own life because, "There you go again, giving a fuck when you don't have to."
If he then asks the patient to take off her shirt so he can listen to her lungs and he sees a pigmented lesion on her shoulder, a melanoma perhaps, then he has now got himself a new problem, which will take yet more time, and he still has that waiting room full of patients, which is getting to look like a runway at Logan in a snowstorm.
Of course, in medical school, you are taught to be curious, to ask the next question, to uncover the most serious illness. Or, actually, I have to correct myself. Once upon a time, in the days of the dinosaurs, medical students were taught that.
Now, in the days of commercial medicine, young doctors are taught to do a "focused" history and a "focused physical exam" which means, do not expand the inquiry, do not open that can of worms. "Keep your shirt on" for today's young doctors means listen to the chest with the patient's shirt on so you will not see the melanoma. If you do see that melanoma, tell the patient to come back for another visit: It's another fee for that problem, and you save time. Of course, if the patient doesn't get the message and never follows up once her cough is better, well she dies.
When I listen to a song like "Anything Goes" I am delighted and play it over and over again, but my son, a musician, hears it entirely differently. When he has me look at the sheet music and break it down, it becomes a lot of work. There is syncopation, and notes coming in with exquisite timing between other notes, the left hand playing against the right with precision. That song is work for the musician, pleasure for the dilettante listener.
My brother, a very sophisticated doctor, loves watching shows on business and finance in large part because, fundamentally, he's never been trained in that, so he loves hearing about it and he's fascinated. Had he gone to Wharton, it would just be work. But now he's a sort of instant expert because he's heard the show about some financial topic.
Listening to people who David Brooks would call, "Low information voters" talk about the virtues of Donald Trump vs Hillary Clinton, you see the pleasure they get talking about what they know next to nothing about. A woman will say, "Well, Hillary's a crook. She belongs in jail," and she beams as if she's just said something brilliant and should be appointed mayor.
How often have I heard some HVAC repairman tell me Social Security is going bankrupt and won't be there for him, or Medicare doesn't work, when his parents are kept off his budget by Medicare?
And, here in New Hampshire, how often did I hear Obamacare called a disaster, when for all intents and purposes, Obamacare never got instituted here, not like in New York, where my sons could get the best health insurance they ever had for a quarter of the cost of their previous policies which covered almost nothing?
Somehow, being incurious, cleaving to "what I heard" from some other ignoramus releases a warm and delicious feeling deep inside.
Another scene from "The Wire"--at a meeting with the drug kingpin, Stringer Bell, some hopper or tout from the streets, who sells the drugs says something which reveals how little he knows about the business. This happens during a meeting which Bell has insisted be run according to Roberts Rules of Order. Bell explodes, and cuts off the hopper but the "parliamentarian" tries to intervene, "Uh, String, he did have the floor."
Bell erupts, "This nigger too ignorant to have the floor."
Ah, but for a moment the hopper felt fine, having expressed his uninformed opinion and having been taken seriously, until the consequences ensued.
Ignorance, for a time, is bliss.
 |
| Belief can be a warm fuzzy feeling |
When a physician, has forty patients scheduled to be seen in eight hours, and he is confronted by a person he thinks is in the exam room because she has a cough, but it turns out she is actually short of breath and has just got back from a 20 hour airplane ride, and she has not just a cough but "dyspnea" the sense of air hunger, then the physician begins to regret asking more questions than the minimum. Now he is faced not with a 10 minute patient with a viral respiratory infection, but a possible pulmonary embolus (lung clot) which gets to be a 40 minute patient. He has, in the immortal words of The Wire's Bunk complicated and burdened his own life because, "There you go again, giving a fuck when you don't have to."
If he then asks the patient to take off her shirt so he can listen to her lungs and he sees a pigmented lesion on her shoulder, a melanoma perhaps, then he has now got himself a new problem, which will take yet more time, and he still has that waiting room full of patients, which is getting to look like a runway at Logan in a snowstorm.
 |
| Better not to ask too many questions |
Of course, in medical school, you are taught to be curious, to ask the next question, to uncover the most serious illness. Or, actually, I have to correct myself. Once upon a time, in the days of the dinosaurs, medical students were taught that.
Now, in the days of commercial medicine, young doctors are taught to do a "focused" history and a "focused physical exam" which means, do not expand the inquiry, do not open that can of worms. "Keep your shirt on" for today's young doctors means listen to the chest with the patient's shirt on so you will not see the melanoma. If you do see that melanoma, tell the patient to come back for another visit: It's another fee for that problem, and you save time. Of course, if the patient doesn't get the message and never follows up once her cough is better, well she dies.
When I listen to a song like "Anything Goes" I am delighted and play it over and over again, but my son, a musician, hears it entirely differently. When he has me look at the sheet music and break it down, it becomes a lot of work. There is syncopation, and notes coming in with exquisite timing between other notes, the left hand playing against the right with precision. That song is work for the musician, pleasure for the dilettante listener.
 |
| I'm just enjoying the music |
My brother, a very sophisticated doctor, loves watching shows on business and finance in large part because, fundamentally, he's never been trained in that, so he loves hearing about it and he's fascinated. Had he gone to Wharton, it would just be work. But now he's a sort of instant expert because he's heard the show about some financial topic.
Listening to people who David Brooks would call, "Low information voters" talk about the virtues of Donald Trump vs Hillary Clinton, you see the pleasure they get talking about what they know next to nothing about. A woman will say, "Well, Hillary's a crook. She belongs in jail," and she beams as if she's just said something brilliant and should be appointed mayor.
How often have I heard some HVAC repairman tell me Social Security is going bankrupt and won't be there for him, or Medicare doesn't work, when his parents are kept off his budget by Medicare?
And, here in New Hampshire, how often did I hear Obamacare called a disaster, when for all intents and purposes, Obamacare never got instituted here, not like in New York, where my sons could get the best health insurance they ever had for a quarter of the cost of their previous policies which covered almost nothing?
 |
| Knowing more, sometimes, is disturbing |
Somehow, being incurious, cleaving to "what I heard" from some other ignoramus releases a warm and delicious feeling deep inside.
Another scene from "The Wire"--at a meeting with the drug kingpin, Stringer Bell, some hopper or tout from the streets, who sells the drugs says something which reveals how little he knows about the business. This happens during a meeting which Bell has insisted be run according to Roberts Rules of Order. Bell explodes, and cuts off the hopper but the "parliamentarian" tries to intervene, "Uh, String, he did have the floor."
Bell erupts, "This nigger too ignorant to have the floor."
Ah, but for a moment the hopper felt fine, having expressed his uninformed opinion and having been taken seriously, until the consequences ensued.
Ignorance, for a time, is bliss.
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