Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Mental Models

Usain Bolt breaking the 100 meter world and Olympic records at the 2008 Beijing Olympics. Public domain, wikipedia.org.


Healthcare professionals face myriad challenges regularly. Empowering ourselves to think creatively and advocate for our patients’ best interests will lead to professional fulfillment and better care for patients.

We used to think it was impossible to break the four-minute mile, never dreamed of carrying more knowledge than all the world’s libraries in our pockets, and couldn’t imagine propelling something that we built beyond our sun’s grasp. Today, we know that these and greater achievements are well within reach. While new technologies and techniques broaden our horizons, it isn’t the tools and information we’re missing which limit our progress most—it’s our own beliefs about what we can accomplish and what we can’t.



In healthcare, our inner blueprints of the system surrounding us and the parts we play on its stage constrain us more than we realize. Sometimes, these representations are ours uniquely and other times they are misconceptions conditioned by our healthcare system. Careful examination of our own mental models is real action that we can take, right now, to make ourselves more effective for our patients and for one another.




Is it possible to develop better ways of doing things without expensive equipment, training for certification as a sub-sub-specialist, a lab at an ivory tower institution, or a huge research grant? Of course it is. That we associate innovation with cost and lab coats is a result of our culture and our own thoughts. Innovation is the domain of everyone who cares deeply about their work and what it means for patients and our world. If we allow misconceptions to linger when it’s possible to advance the science of our work, that’s on us. In fact, unless we see our system as flawless, innovation is an essential responsibility. We’re all innovators. Every one of us has the power to make meaningful contributions to improve the ways our system engages with and supports patients.




A system focused on billing and reimbursement before quality has influenced perceptions about roles and expertise. To become a high-performing diagnostician, you don’t need to apply for a fellowship or obtain an advanced degree. You need a curious, attentive mind and the capacity to find and apply new knowledge to your clinical skills. You don’t need to be a physician to help make a diagnosis—many can participate in the collaborative process of identifying the root cause of illness. If this clashes with your beliefs, reflect sincerely on their source. Like all of healthcare, diagnosis is a team sport. In the art of finding constellations among points of clinical data, title and degree will always be second to effort and presence. Crucial clinical information declares itself often to those who care to receive it, no matter their role. To those who are present, patterns will emerge. To those who are not, licensure won’t help.




We’ve allowed insurers to tell us what we can do and when, and the result is an artificial barrier between ourselves and our patients’ problems. When we discharge a patient into a situation that affects his likelihood of becoming sicker, we feel the schism between the work we want to do and how the system lets us do it. This dissonance comes from emphasis on high-priced care, and it’s flourished because of passivity on our parts as providers. The healthcare conglomerate is supposed to work for us, not we for it, and each time we fail to assert control we falter in our commitments to our patients.



Some constraints exist outside of our control and we should work diligently to remove them. But too often, our own mental models limit us more than external factors. When you encounter your next unsolvable problem, pause and check whether the barrier is as real as you perceive it to be.