Curiosity: Some musings

Some thoughts on curiosity in medicine

I had the honour of being part of the final SMACC conference, as one of a series of people interviewed for a segment entitled “Pacific Island Playlist”. In preparation, I was asked to consider one piece of advice for the audience. My advice: be curious. Originally, I was thinking mostly in terms of science and questioning inherited wisdom, but I quickly realized that curiosity was essential to what I considered good clinical practice, as well as a good life. What follows is some rambling thoughts on the value of curiosity.

Busting myths: The value of curiosity in medical science

Anyone who follows this blog knows that I am a sucker for medical myths. I love getting deep into the medical literature. Whether we are talking stress testing, tPa for stroke, heparin for ACS, pediatric UTI, or topical anesthetics for corneal abrasions, the process is the same: ask questions and search for answers.

This process, questioning everything and using the scientific method to determine the best possible answer, is what defines skepticism. I am a skeptic.

In part, skeptics are driven by the value of truth. However, a deeper motivation to ask questions, and then follow those questions with (occasionally painful) searches for answers, is curiosity. Curiosity is the fuel that fires the engines of science.

I have no special talents. I am only passionately curious.
– Albert Einstein

Understanding our patients: Clinical curiosity

Some years ago, I adopted a mantra that I repeat to myself as I enter the department before every shift: “Stay curious”.

Although the association between curiosity and science may be more obvious, I think value of curiosity is even greater for clinicians. Curiosity is essential to understanding our patients. We are all well trained to ask questions about symptoms, but curiosity is what pushes us to persist when the symptoms are vague or unusual. Curiosity is what drives us to move beyond the symptoms, and ask about the patient.

I am sure we have all witnessed the value of curiosity in emergency medicine. We have all seen the value of exploring “why?” Why are you here? Why are you worried? I am sure we have all spent hours with a patient with vague symptoms, gathering tests and repeating exams, only for the true purpose of the visit to materialize at the last moment. A work note was required, or his best friend was just diagnosed with cancer and he just wanted to get checked. A few moments of curiosity at the beginning of a visit not only gets you better answers, but can also save you a lot of unnecessary work.

Routine medical questions don’t paint a picture of the patient’s living environment. Routine medical questions don’t shine light on the family dynamics underlying an end of life discussion. Routine medical questions won’t tell you that a patient isn’t taking their medication because they can’t read the bottle (or at all). Routine medical questions don’t, but curiosity does.

I think we all recognize the value of curiosity, but it generally isn’t taught, and it is easy to forget. When we are tired, or rushed, we abandon curiosity and focus on the routine. But we don’t have routine jobs. Our patients need more than routine. Hence the mantra. “Stay curious”.

Better education: Being curious about your learners

One of the best educators I have ever met – Dr Rick Penciner – taught me very early in my career to “diagnose the learner”. The idea is that learners arrive for shifts with different backgrounds, different baseline knowledge, and different needs. Rick would start each shift with a few minutes of questions. These were not rote or routine. Rick was truly interested in the learner. He was curious.

Although I frequently fail, I try to bring this level of curiosity to education. What does this learner need from me? What do I have to offer? How can I improve?

A sense of curiosity is nature’s original school of education.
– Smiley Blanton

Better learning: Curiosity as a drive in lifelong learning

To excel in medicine, you must continue to learn, no matter how long you have been practicing. Being curious is an excellent way to stay motivated in this journey.

A significant change is underway in the world. Knowledge is cheap, and getting cheaper. The value of memorization is diminished daily by the ubiquitous availability of facts. Medical school has traditionally been about memorizing vast quantities of esoteric information, but those facts are now freely available online. Thus, I imagine the job of the physician will change drastically in the coming decades.

However, the internet can only answer questions that have already been asked. Curiosity, as a source of novelty and previously unasked questions, will likely become more valuable as the retention of facts becomes less.

Judge a man by his questions rather than by his answers
– Voltaire

Curiosity in relationships: Avoiding the fundamental attribution error

Even in our closest relationships, other human minds are inaccessible. All of our relationships involve a myriad of assumptions, and occasionally those assumptions lead us astray.

When I make a mistake, I can always point to mitigating factors; to reasons for the error that have nothing to do with me. I know I didn’t screw up on purpose. However, when other people make mistakes, our first instinct is often to assume some fundamental character flaw; they are stupid, or lazy, or mean. This is the fundamental attribution error, and curiosity can help us avoid it.

In one of the great SMACC talks, Dr. Jenny Rudolph taught us to reframe “WTF!?!” into “what’s their frame?” This is all about curiosity. It is about exploring the motive behind actions. It is about the drive to understand our colleagues rather than rushing to judgement.

Not only will curiosity diffuse the our initial negative emotions, but it is also the first step towards a solution. If we think errors were the result of a fundamental character flaw, there really isn’t much we can do to fix them. (You can’t fix stupid). However, if we follow our curiosity into the broader causes of an error, we will be given the ingredients required for a solution.

A rich life

When you’re curious you find lots of interesting things to do.
– Walt Disney

Curiosity can transform mundane into fascinating. The world is incredible. Around every corner there is mystery.

Curiosity will lead each of us in different directions. One person might be interested in human psychology, while another is fascinated by the physical underpinnings of consciousness. It could be chemical reactions occuring while baking, or perhaps the history of the ingredients on your kitchen counter. You might be intrigued by the technology in your phone, or wonder about the future and what a phone might look like in 100 years. But whatever direction it leads, curiosity drives us to be more engaged with the world.

Being curious about your city will lead you to explore, transforming a boring Wednesday into an unexpected day of local travel. Being curious about the ideal job may help you find your career, or at least find ways to improve the job you already have. Being curious about fun may lead to a hobby you had never imagined.

I am always astounded, and sometimes overwhelmed, by the number of different types of life I could decide to lead. How could you possibly know what makes you happy if you don’t follow your curiosity and explore?

The Cure for Boredom Is Curiosity. There Is No Cure for Curiosity.
– Dorthy Parker

Some curiosity science

I think a lot of the benefits of curiosity are self evident, but as I thought more about the effects of curiosity, I became rather curious about the science of curiosity. There are a lot of problems with the science (as there almost always are with psychological research), but there were some interesting benefits associated with being curious that are worth mentioning.

Not surprisingly, when you are curious, you learn better and perform better in school. (Kang 2009; von Stumm 2011) However, I think it is interesting that you don’t just remember the things you are were curious about. Even incidental information presented to people in a curious state is remembered better. (Gruber 2014) At a neurophysiologic level, curiosity seems to activate dopamine driven pleasure and reward pathways, presumably indicating its importance as an intrinsic reward system to seeking new knowledge. (Gruber 2014)

Curiosity is tied to a greater likelihood of developing new intimate relationships, and higher ratings of closeness and attraction. (Kashdan 2004; Kasdan 2011) A curious personality is associated with increased tolerance of anxiety and uncertainty, positive emotional expressiveness, initiation of humor and playfulness, unconventional thinking, and a nondefensive, noncritical attitude (Kashdan 2013) High states of curiosity have even been associated with lower mortality. (Swan 1996)

Many of the associations will disappear with further research. They also may not be very helpful. An association doesn’t mean that you can force yourself to be more curious, and therefore improve your life. However, I was curious about curiosity science, so I decided to include it here.

Curiosity is one of the great secrets of happiness.
– Bryant H. McGill

It’s not a panacea: Some problems with curiosity

I’ve been pretty positive so far, but I should be clear: curiosity is not a panacea. You can cleary go to far. Too much curiosity about people and you become a snoop or a gossip. Too much curiosity about morbid topics can lead to dark places.

In medicine, there is a risk of delayed action with critically ill patients if we spend too much time asking questions or stuck in our heads. Efficiency is also a risk, as a few extra minutes with every patient can quickly add up, and result in patients languishing in the waiting room.

Curiosity can be overwhelming. The sheer number of questions I have jotted down, with the intention of eventually exploring in the medical literature, is sometimes an obstacle to tackling any one question.

I frequently found myself in trouble at school because I was too curious. I asked too many questions. I was a “troublemaker”. Curiosity can lead to trouble. One of the very first stories, the biblical Adam and Eve, is a parable about the dangers of curiosity and knowledge. Of course, curiosity is only really dangerous to people threatened by truth, either because they do not possess it or they are trying to hide it.

This fear of curiosity highlights its power. Curiosity will help you burst your intellectual bubble. Journalistic curiosity is what keeps our governments in check. There is tremendous power in asking questions and seeking answers.

Curiosity is insubordination in its purest form.
– Vladimir Nabokov

Curiosity is not static

Curiosity seems to come more naturally to some people than others, but we all have it. Watch any toddler interact with the world and it becomes obvious that were were all born curious. Unfortunately, life seems to get in the way. We get too busy for exploration. We don’t want to appear silly when asking questions.

I think childish curiosity can and should be relearned.

You can’t force it. Curiosity – learning new things – is fundamentally enjoyable, as long as they are things that you want to learn. My curiosity doesn’t have to look like yours. I might be curious about the role of p values in medical research, but that probably sounds awful to you. You might be interested in pop culture or the sex lives of earthworms, and I won’t judge you for that. Curiosity leads to a rich and enjoyable life as long as you follow it down the paths that interest you.

Curiosity requires time and energy. Understandably, as we get tired and busy, it often seems easier to continue with the status quo, rather than asking questions, even if the answers to those questions could be incredibly valuable. But curiosity can be easy.

I practice curiosity for a few minutes every day. I have an app that sends me a message twice a day at completely random times. Whenever I get that message (“be curious”), I stop, observe the world around me, and spend 1 minute asking questions. There are no limits on the questions. Sometimes it’s about physics, sometimes psychology, sometimes a patient in front of me, and sometimes about myself. Most of the questions aren’t that important, and often I don’t have time to search for answers. But at least once a week, I will explore at least one question in a little more depth. I think this exercise has helped me develop a habit of curiosity. I still frequently fail, especially when tired, but I find myself asking more questions, learning more about my patients, and learning more in general.

A curiosity mindset: Humble pride

I think the practice of curiosity can help create a good mental state, which I will call humble pride. One the one hand, curiosity certainly keeps you humble. If you practice curiosity every day, you will ask hundred of questions, the vast majority of which you have no hope of answering. Each question seems to lead to 5 more, constantly highlighting the extent of your ignorance. Such ignorance cannot help but keep one humble.

On the other hand, being curious also means seeking answers to questions. It is a drive to lifelong learning. With a daily practice of curiosity, one cannot help but learn and improve every day. That learning is a great source of pride.

This balance – the acknowledgement of a vast ignorance, but the faith in one’s abilities to answers questions when necessary – is, in my opinion, a great mindset for life.

Curiosity is a willing, a proud, an eager confession of ignorance.
– S. Leonard Rubinstein

Summary

I think medicine would be better with more curiosity. I think life is better with more curiosity. However, curiosity alone is not enough. Toddlers are curious, but rarely accomplish much. However, the combination of curiosity and perseverance is incredibly powerful. And the best part is that curiosity is free. You just have to start using it.


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References

Gruber M, Gelman B, Ranganath C. States of Curiosity Modulate Hippocampus-Dependent Learning via the Dopaminergic Circuit Neuron. 2014; 84(2):486-496.

Kang MJ, Hsu M, Krajbich IM, et al. The Wick in the Candle of Learning Psychol Sci. 2009; 20(8):963-973.

Kashdan TB, Roberts JE. Trait and State Curiosity in the Genesis of Intimacy: Differentiation From Related Constructs Journal of Social and Clinical Psychology. 2004; 23(6):792-816.

Kashdan TB, McKnight PE, Fincham FD, Rose P. When curiosity breeds intimacy: taking advantage of intimacy opportunities and transforming boring conversations. Journal of personality. 2011; 79(6):1369-402.

Kashdan TB, Sherman RA, Yarbro J, Funder DC. How are curious people viewed and how do they behave in social situations? From the perspectives of self, friends, parents, and unacquainted observers. Journal of personality. 2013; 81(2):142-54.

Swan GE, Carmelli D. Curiosity and mortality in aging adults: A 5-year follow-up of the Western Collaborative Group Study. Psychology and Aging. 1996; 11(3):449-453.

von Stumm S, Hell B, Chamorro-Premuzic T. The Hungry Mind Perspect Psychol Sci. 2011; 6(6):574-588.

Cite this article as: Justin Morgenstern, "Curiosity: Some musings", First10EM blog, April 15, 2019. Available at: https://first10em.com/curiosity-some-musings/.

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