The foremost decision is the decision to provide treatment
Last week I met a colleague who leads a community college program on auto maintenance and repair. This arena of study and practice has always seemed fairly straightforward to me: learn the mechanics of engines and other things that make cars work, and learn how to fix them. I confess it was surprising to me when he shared that the most important skills his students need to learn are critical judgment, reflection and decision-making. That’s partly because car design has changed so dramatically over the last two decades that cars have become complex electronic as well as mechanical systems. Just like in health care, for a good mechanic the foremost decision is whether to provide treatment.
Who knew that our most important teaching goals and teaching challenges – his in auto repair and mine in counselling and health behaviour change – were so aligned?
This reminded me of another conversation I had with a surgeon a couple of years ago. We were talking about laparoscopic surgery, and I wondered whether today’s medical students had a learning advantage due to their years of experience playing videogames. The doctor stated that it doesn’t take long to teach anyone to how to perform laparoscopies (although video game players might learn a little faster). He said that what takes years to teach and learn is when not to do the surgery.
When and how to intervene may be the most challenging things for anyone to learn because the skills are so complex. Education for diverse fields of practice – from car repair to medicine and lots in between – demands that students master three essential foundation skills:
1. Critical reflection: Meaning-making and interrogating the limits of one’s knowledge and skills; considering costs, benefits and outcomes of different possibilities
2. Attention: Including listening, observation and data-gathering, from a stance of care and concern
3. Decision-making: This includes decisions regarding a specific course of action, as well as decisions about what additional information might be needed; acting with integrity and ethics.
A nice article on how diagnosis is more art than science features wisdom from “master diagnosticians”, and underlines the importance of the above three skills, along with humility and a commitment to continuous learning:
“If you want to be a master diagnostician,” says Dr. Lewin, ”you’d better be prepared to be a master student.” It’s a lesson Dr. Goodgold, now in his fifth decade of practice, still takes to heart. ”Being a good diagnostician means being good at solving problems. It starts with being intellectually honest. You must admit to yourself that you don’t know everything. Not a week goes by that I don’t see something new. I must continue to be a student of medicine and science.”
Consider the wisdom of Sherlock Holmes, who was modeled by his creator, Sir Arthur Conan Doyle (a physician turned fiction writer), after one of the most renowned diagnosticians of his day: Dr. Joseph Bell, professor of medicine at the University of Edinburgh. ”I see no more than you,” the super sleuth explained to his sidekick, Dr. Watson, ”but I have trained myself to notice what I see.”