Takeaway
Dan Pink distills pearls of wisdom for health professionals from his bestselling books "A Whole New Mind" and "When."
Lifelong Learning in Clinical Excellence | February 11, 2019 | 5 min read
By Sam Kant, MD, Johns Hopkins University School of Medicine
Some of the most effective and lifesaving ideas in medicine come from other fields. Often, a search for solutions to perennial issues leads to answers in unlikely places. Few authors have the inordinate ability to make connections between seemingly disparate things. One such author is Daniel Pink.
On a midweek afternoon, in between trying to piece together strings of a bustling work day, I spoke with Dan about how he is able to converge aspects from separate fields into a whole new inspiring idea. He said, “I am very curious and enjoy reading across different disciplines. People often tend to read and talk to people only in their own domains. I like talking to people and reading about many different domains, which ends up giving you a very different view of things.”
A Whole New Mind
One of his earlier books, A Whole New Mind, focused on how right-sided brain attributes (intuitive & holistic) are the need of the future, in order to balance the left brain attributes (logical & analytical) which have dominated Western society throughout much of the past. Humanism and listening skills, two right-sided traits, are making a comeback in medicine.
Dan has a recommendation for educators in medicine to imbue these essential qualities in future stalwarts:
It is important for physicians to model the behavior of empathetic listening, paying attention to patient stories and questions, rather than thinking of the patient as merely an algorithm or a mechanical problem … Narrative medicine and art-based training is helpful for diagnosticians. It not a replacement for diagnostics – it is an accompaniment and creates better doctors. It is ever more important in the coming age of artificial intelligence – diagnosis can sometimes be done by decision trees and software. It is great to have the humanistic observation skills of a painter and the listening skills of a musician.
When
When approaching problems, organizations can be consumed by ‘what’ and ‘why,’ but a third dimension of ‘when’ is important to consider. In his most recent book, When: The Scientific Secrets of Perfects Timing, Pink illuminated surprising aspects of patient care that are influenced by timing. Anesthetists administering the wrong dosage, gastroenterologists missing polyps during colonoscopies, internists prescribing unnecessary antibiotics, and healthcare providers not washing their hands – all of these events have a common focal point of occurrence: the afternoon, when, in general, people are more tired. So if there is evidence of the common timing of these adverse events, why is this not being widely factored into clinical situations? Dan said:
I actually don’t know why. We take questions like what to do, who is going do it seriously, but when it comes to when we do things, we think it doesn’t matter. The evidence is overwhelming to support the when. As with most individuals, a physician’s brain power is not the same all throughout the day – it changes, and if you know how it changes, you can do something about it and be better at your job. Whether your job is to write books, or patrol streets, or treat patients.
Impeccable patient care is a round the clock effort. Since the afternoon can be a challenging time of day, Dan suggested, “First of all recognize it, and then take small steps to mitigate it. Healthcare has taken some measures to address this, but providers should take more breaks, and certain kinds of breaks – for example taking a walk outside.”
The socioeconomic connection
It is important to recognize socioeconomic factors associated with disease. There is robust evidence that unequivocally ties these factors to health outcomes. Dan said, “With respect to healthcare outcomes, lower income groups have more severe asthma. We need to talk about this more, that everyone does not get an equal start. From the biology to the psychology, it is different being poor than being middle class.” Dan continues, citing, “Scarcity: Why Having Too Little Means So Much.”
When people feel scarcity in their lives, they make different and worse decisions. If someone, with scarce resources, is trying to figure out whether to pay the phone bill or electricity bill, that person is going to be more likely to eat unhealthy food since the decision-making capacities have been hobbled by that scarcity in an entirely different realm. Upper middle class people who don’t have to use their brain under constant conditions of stress and scarcity make different decisions: not because they are morally better, but because their brain is less taxed by scarcity.
The importance of a strong ending when interacting with patients
As we approached the end of our interview, a befitting question came to the fore – how endings have higher meaning, in comparison to the many other parts of a story. This emphasis on endings is applicable to patient interactions. Research has shown that at the heart of a meaningful ending lies a complex human emotion: poignancy (a mix of happiness and sadness).
Dan puts it eloquently:
Endings have a disproportionate effect on us. Human beings are meaning-seeking creatures, and there is an association of endings with meaning. How that came to be, we are not certain … perhaps the recency effect make endings more salient. Given this association between endings and meaning, there is an opportunity in medicine (and other professions) to be much more intentional about endings. For me, one of the big takeaways from the book “When” was being more conscious of how things end – whether it’s a meeting, social engagement, a talk, an interview, or an interaction with a patient.
Driving home after our interview, the colors of the setting sun gave the Baltimore skyline a new character, a moving quotation from Dan’s book made me reflect on endings in a new light came to mind:
The best endings don’t leave us happy. Instead, they produce something richer – a rush of unexpected insight, a fleeting moment of transcendence, the possibility that by discarding what we wanted we’ve gotten what we need.