May we just be open to learning from anyone and everyone.
I believe very deeply in transdisciplinary education. It is a concept I first learnt during my PhD and is increasingly valued in research communities.
In this model, students learn concepts, ideas and problems from fields outside of their own, and look for commonalities to build connections and strengthen understanding within their discipline. In short, it encourages knowledge transfer, innovation and inspires new insights, by learning outside of traditional discipline-specific education models and teachers.
Many scientists have made historic breakthroughs and world-changing discoveries through transdisciplinary and interdisciplinary learning. Essayist and physicist Joshua Roebke’s piece uniquely explains how principles of time and reality in Latin American fiction helped him better understand experimental physics. Leonardo Da Vinci, the renaissance man, understood the fundamental truth about transdisciplinary learning; it enriches our knowledge in every field.
The traditional model of western medical education does not typically consider such things.
As medical students, we are predominantly taught by doctors and trained within the narrow confines and tightly protected field of clinical medicine. I recall a scattered few lectures by medical librarians (“How to find something in an online or physical library”), public health and social scientists (“What are the social determinants of health”) and perhaps a psychologist or two, but mostly we were educated by doctors skilled and qualified enough to teach the material.
History-taking, as an example, taught in first-year medicine by clinical tutors, as one of the most important and fundamental skills needed as doctors. We learnt and practiced and now use so many variations of medical history-taking: the cardiac history, the sexual history, the gastrointestinal history, red flags for each system and corresponding safety-plans. Each checklist of questions to ask and issues to explore was memorised by the end of medical school. Within months of practice, these history-taking templates became second nature and the most natural way we gather information as doctors.
Almost 15 years of practicing medicine has helped me learn history-taking, and how best to collect the information I need for my formulation, diagnosis and subsequent treatment plan.
In general practice, particularly, I can breeze through most systems reviews, practiced at jumping between different systems and symptoms, messily but cohesively searching for the “patterns” within the jumble of information offered to me by the patients.
They don’t know the systems reviews, you see, so they don’t answer the questions in the order in which we learn them, phrased with the clarity that would be immediately identifiable, or with the brevity that our 10 to 15-minute-long appointments allow. The patient, after all, is not a textbook.
Therefore, if we do not accurately collect and synthesise the information given to us by real-life patients, we will pursue the wrong examination, the wrong conclusion, the wrong plan and the wrong treatment. How often do we drill into the medical students: 70-90% of the diagnosis comes from the history alone?
Patients often do not believe me when I explain this, when I am reassuring them that I’ve understood their problem and can suggest a reasonable plan, that they do not need an MRI to prove this diagnosis. Patients believe in subjective proof, in scan results and tests and things they can measure.
At times investigations are essential, and at worst failing to arrange investigations could be considered complete negligence. But in many low-acuity and low-risk common presentations, we, GPs especially, can comfortably, safely and accurately formulate a diagnosis and plan based almost entirely on information collected during history taking.
But are we, medical doctors, truly the most skilled at teaching history taking? Is there no one better than us, that could teach our medical students the most artful, thoughtful, accurate and comprehensive way to collect information, verbally, from another human?
I am currently studying a Master of Liberal Arts, Extension Studies in Creative Writing and Literature from Harvard University. The long explanation of why I am studying this is a column for another day, but in short: transdisciplinary learning.
One of my classes last semester was about memoir writing and taught by an investigative journalist who has published extensively in mainstream newspapers, magazines and books. We spent weeks understanding how reporters interview people, and collect information that is accurate, confirmable, detailed, and emotional. We were given an assignment to interview someone about an important moment in their life and then recreate and reconstruct the scene in a narrative so detailed the reader would feel completely immersed and wanting for nothing from the rich, specific descriptions of scene, time, person, emotion and fact.
We read so many pieces of investigative journalism, and even small throwaway lines (“In his fridge there was a watermelon and two cans of beer”, “They met in the third grade, on the first day, both in new orange jackets”, and “At 10.07am, she heard the shot.”) had me humbled. The professor pointed out each time: “This happened four years ago. The journalist wasn’t there. How did she know what was in the fridge?” or “How do we know the jackets were orange? The journalist probably asked questions like “Do you remember what you were wearing?” “Do you remember the weather that day?” “Can you describe in as much detail as you can what your first day was like?”
If I am given the task of finding out what you did yesterday, as an investigative journalist I would probably start with questions like: Where were you when you woke up? What does your bedroom look like? What time did you wake up? What did you do on waking? Can you describe how you felt when you woke up? What were you wearing to bed? What is your normal morning schedule? Was it any different yesterday to your normal routine– if yes, how and why? What did you eat? How did you prepare that? Can you describe the coffee to me?
It would take me half an hour to collect information about just the first few minutes and hours of your day, but the questions asked from a journalist’s perspective would be insightful, exploratory and rich in detail.
In contrast, if I asked a patient what they did the day before – let’s say they have sat down in my clinic room and opened with “Doc, I just feel off. Since yesterday” – there’s a thousand ways the conversation could unfold and already I am on high alert that this patient probably needs an urgent ECG, influenced by the years of my distrust of vague symptoms and how often such a consult has ended with paramedics rushing in to escort away this patient having a STEMI. “I just felt off, doc. I dunno. Just tired, maybe.”
Still, I’d try an open-ended “Okay, tell me loads more, with as much detail as you can”, or “What does ‘off’ mean, exactly”, and then as I felt the heavy weight of the clock, inevitably would try and focus and redirect the patient with a collection of specific, closed questions.
That is not an unreasonable approach, after all, I don’t have half a day with each patient to collect information the way a journalist would.
But, having now been taught information-gathering from both medical doctors and journalists, I, yet again, believe that some aspects of medical education could be enhanced by learning from colleagues in other disciplines.
My clinical history-taking has been substantially improved from the principles I have learnt from my journalism professors. After all, I did not know what I did not know, and while we are experts in clinical medicine and all that it encompasses, journalists are expert in information gathering, reporting and communicating.
And those are skills we use every day, skills that are fundamental to the practice of safe, patient-centred medicine, but never was I taught by a journalist, only now that I am studying a course seemingly entirely unrelated to clinical medicine.
Journalists cannot teach us how to insert arterial lines, obviously, but neither can I teach a paediatric resident how to insert an intraosseous needle. That is outside of my personal scope of knowledge. But I can explain biological change and development during adolescence to a high school educator, and she might perhaps make better teaching plans for her students. And a newspaper reporter might teach me how to ask questions to best collect information, and I might use her strategies in my clinical practice to make more considered diagnoses.
We have much to embrace from transdisciplinary education, but I fear that medicine may be too ego-driven to allow for such a thing in standardised medical training. Still, I will shout from the rooftops, perhaps with vocal strength taught to me by a musician, that we can be better doctors by learning transferrable and new skills from other disciplines and non-medical professionals.
We do not know what we do not know.
May we just be open to learning from anyone and everyone, and perhaps a physicist will give us a spark of something that lights up a dark, rusty corner in a recess of our clinical medicine minds, and we will later thank her for the fire of knowledge that subsequently amassed.
Dr Pallavi Prathivadi is a Melbourne GP, member of the Eastern Melbourne PHN Clinical and Practice Council, and GP Lead of the RACGP Academic Post cohort support and education program. She holds a PhD in safe opioid prescribing and was a Fulbright Scholar at the Stanford University School of Medicine. She is studying creative writing at Harvard University’s Division of Continuing Education.
