Nursemaids

For those unfamiliar with my health travails this summer, I had a mesenteric venous thrombosis — basically a blockage in the primary vein in my bowel. As such, I’ve been plunged into our health care system in far more depth than I ever intended. I wish I could tell you that being bedridden gives one plenty of time to think, but it turns out when your primary energetic systems aren’t working very well, your brain does a poor job of keeping up. My problems were in my small intestine, which is where you absorb the energy from the food you eat. And when you couple that with a morphine derivative (I was on two separate starvation diets both lasting approximately a week) you don’t get many new thoughts.

But I’m pulling out of it. And there’s nothing like having real skin in the game to make you realize how your medical care is actually operating on your system. I am not particularly medically literate — I do count on my medical professionals to tell me what’s going on. And, not surprisingly, I’m observing them — predominantly what v-Meme they’re operating under. Why? It matters deeply what knowledge structures your doctors use. Are they sophisticated thinkers, breaking down symptoms, and matching them to different titrated medicines? Or are they root cause analysts, asking that question “how did this patient end up in front of me in the first place?”

Depending on the problem you have, there are needs in the medical system for both kinds. Sometimes, knowing why you have a given condition really doesn’t do you much good. Other times, it may save your life. But the reality is that we are overwhelmed with the level that different mental models are ingrained in our understanding of medicine.

Which is fascinating — because our brains don’t really care. Brains are alternatively wired and biased toward evolutionary thinking, or sophisticated thinking. For those that haven’t pored through all the pages of this blog, the short-version upshot is this: sophisticated thinking has lots of fine-grained thinking, fractal, and self-similar; and evolved thinking is doing the pattern matching across domains that seems obvious — you drank too much, and now your liver is on the fritz. But when you back off from both your liver, and the drinking, one can see that this level of pattern matching requires being able to see things not only in the realm of cause-and-effect, but also across very different behaviors and symptoms. You drank wine because you were at an event. Now, your liver produces unbalanced levels of enzymes. This is VERY different than dialing in the exact dose of a given medicine, which occupies the same cognitive domain.

And your brain only knows the containers you’ve generated for it. So if your relational diversity is low, and grounding is weak, expect more sophistication, though there’s also no question that a good, sophisticated doctor will augment their knowledge through feedback loops with a number of patients.

But the second — the evolved, root cause thinker — has to follow a different path. I wish I could tell you I’ve done an extensive background survey with every doctor I’ve identified as a root cause thinker. I haven’t. But it’s pretty quick to the point of “I know it when I see it.”

So, all you doctors out there that happen across this short column. Something to think about — why do you care about alternately understanding exact dose, or deep reasons behind pathologies? How can you all up your game? I’ve had a pretty arbitrary journey through the medical system — but it would be great to get to a shared realization on why both areas of knowledge development matter to your patients.

And your receptivity is all in your shared experiences and relational development.