Simon recently claimed his new favourite word is pleiotropic, and whilst I don’t want to get into a vocab competition, I offer my own new favourite word: ultracrepidarianism. This is something I am eternally fearful of, but in all likelihood am probably guilty of daily; giving opinions and advice on matters outside of my own knowledge. The origin of the term comes from Pliny the Elder and in Latin states ‘Sutor, ne ultra crepidam’ meaning ‘shoemaker, not above the sandal’. It is alleged to have been uttered after a shoemaker criticised an artist’s work (as depicted above). As a trainee in emergency medicine it often feels as though there is a constant effort to try so very hard to not to come across as the shoemaker did.
The current training programme encourages trainees to reflect on our practice and identify our shortcomings and areas for improvement. Writing prosaic reflections on patient interactions is valuable, and I dare not dispute that. However as part of my reflective practice I like to read. I particularly like to read non-fiction and particularly literature about areas outside of medicine. Having just finished reading ‘Think Like a Freak… How to Think Smarter About Almost Everything‘, by Stephen Dubner and Steven Levitt, I felt inspired to share some lessons I took and how I will apply them to my work. The authors are an economist and a journalist who seek alternative solutions to a diverse selection of problems.
The book argues that the hardest three words to say in the English language are ‘I don’t know’. People don’t want to look silly, incompetent or stupid by admitting when they don’t know something. This is something that we are all guilty of and happens far too frequently. As someone who is on the lower rungs of the career ladder I probably get asked more questions that I don’t know the answer to than those at the top. I would argue that it is important for those at any point of their career to say ‘I don’t know’. Please don’t take this to be advocacy of not trying to work an answer out or not attempting to think of possible answers. There is a caveat; if you are going to say ‘I don’t know’ it comes with a fee, which is that you go and work hard to find out the answer. There is no shame in not knowing everything. Saying these three words can be an empowering first step to increasing your knowledge. I have respect for those that can admit what they don’t know and then go and find out the answer, so much more than for those who ramble and produce some nonsensical answer to try and save face.
The authors make some interesting points about problem solving, that aren’t framed in the context of the medical profession but are readily transferable. Here is what I took as some key points:
Think like an 8-year-old: An 8-year-old has very few preconceptions and is limitlessly curious. If you take that point of view, you can view everything with excitement and wonderment. 8-year-olds ask silly questions and are hungry for knowledge. Thinking like an 8-year-old may help you ask questions that no one has asked
before, no matter how stupid you might feel it is. Essentially don’t be afraid of the obvious.
Ignore the noisy part of a problem: This is the distracting injury, or the screaming patient when you are triaging. Don’t let it suck you in. Obviously some noisy parts of a problem like significant haemorrhage do need your attention, but sometimes it is easy to get absorbed by a problem and you become fixated. Take a break and look at the detail. This is why we add ‘don’t’ ever forget glucose’ to our ABCD algorithm; so that we don’t forget the little things that have a big impact. Define / redefine your problem; say out loud where you are up to and what the problems are.
Question differently; look for answers in different places: If things are not working out and you can’t work out why, change your tack. Stop, and think laterally. Don’t plough on without thinking about the problem. Approaching a problem from a different angle will produce different results. Don’t just do things because they’ve always been done a certain way. Think different; be different.
Think small: The authors discuss that when tackling a problem we should think small. Looking at it this way makes a real difference; trying to tackle a big problem off the bat can be an exercise in futility. Smaller problems are naturally more manageable. . Small questions are not asked as frequently as big questions and therefore are sometimes a new area for learning. Think small, take small problems and solve them. Imagine when you are dealing with a patient with complex social and medical issues; you might not always be able to answer all their problems, but if you break it down into smaller problems you might be able to reach a solution.
Feedback is key: Dubner and Levitt argue that the simpler the task the easier it is to get feedback and likewise, the harder a task, the harder it is to get good feedback. We should be aware of this. It is difficult to give feedback on complex and challenging tasks, yet we must strive to do so. For us in the medical profession, feedback is essential. We get feedback (if we look for it) from every patient interaction; every procedure we do; every diagnosis we make. As trainees we get feedback in the form of work-based assessments. It is important to focus on a small part of a clinical encounter if you are to give truly useful feedback. It is difficult to give feedback on an entire clinical interaction; there are just too many components to mentally attend to.
As primarily a book on economics (of sorts) the authors talk about incentives. Incentives are used everywhere and influence so much of our behaviour. Whilst I won’t go into incentives in the ED now, I just hope for you to ponder on the place incentives have in Emergency Medicine. I believe that they could be used to reduce attendances, increase patient satisfaction and draw more people to the specialty (in the UK); but that is just my opinion.
I wholeheartedly recommend reading any (and all) of the books in the ‘Freakonomics’ series. They really are enlightening and I for one am confident they will influence my approach to work…and life in general. Check out the Freakonomics blog here as well.
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