By: Richard Gunderman, MD, PhD
IU School of Medicine 

When will we learn that to excel as physicians, it is not enough to study medicine? If physicians knew only what we had been required to learn for the innumerable standardized tests we have taken over the course of our careers, we would be ill-equipped indeed to care for patients, one another, or ourselves. Sometimes good test takers turn out to be poor doctors, while some poor test takers excel in patient care.

To excel in medicine, we need to know things that medical school and residency do not necessarily teach us. I am not talking about profession-specific knowledge and skills, such as how to critically evaluate the medical literature, integrate information technology into patient care, or organize and pay for health care. I am talking about something far more essential – namely, how to see.

One might suppose that there is nothing to be learned about seeing. After all, we all have much the same visual apparatus, including such components as a lens, the retina, and the optic nerve. Surely seeing is something we all do naturally, without needing to think about it or cultivate the capacity. Yet this assumption is dead wrong. Like every moment in life, seeing is something we learn to do poorly or well.

Consider the work of the British philosopher and novelist Iris Murdoch, whose descent into dementia was beautifully captured in Richard Eyre’s 2001 Academy Award-winning film, “Iris.” While Murdoch was still in her prime, she produced an essay entitled, “The Idea of Perfection,” in which she tells the hypothetical tale of a mother-in-law who learns to see clearly, justly, and lovingly.

The mother-in-law regards her daughter-in-law as unpolished and lacking in dignity and refinement.  The young woman is good-hearted, but apt to be pert and familiar, brusque, sometimes rude, and always juvenile. The mother-in-law dislikes the way she dresses and feels that her son has married beneath him.  A very “correct” person, she behaves well towards her daughter-in-law, but in her heart, she resents and even despises her.

But the mother-in-law is also an intelligent and well-intentioned person, capable of self-criticism. She takes another look at her daughter-in-law, telling herself, “I am old-fashioned and conventional. I may be prejudiced and narrow-minded. I am certainly jealous.” Nothing changes in the conduct of either the mother-in-law or the daughter-in-law, yet a profound transformation takes place.

The mother-in-law discovers that her daughter-in-law is “not vulgar but refreshingly simple, not undignified but spontaneous, not noisy but gay, not tiresomely juvenile but delightfully youthful, and so on.” Some might attempt to explain away such a change of heart as a kind of self-delusion, but others will recognize what has really happened: she has learned to see her daughter-in-law clearly, justly, and lovingly.

The retelling of such a tale is premised on the hope that what is possible for mothers-in-law is also possible for physicians. We, too, can learn to see more clearly, lovingly, and justly. Circumstances at work and in our personal lives, from overwork to marital and family difficulties, can make us irritable, short-tempered, and quick to condemn. Our mission is not to indulge such inclinations but to reshape them.

Consider another story. A medical student crossing campus one dark, frigid winter night saw a huge figure coming toward him. As the distance between them diminished, he reached for his wallet, prepared to hand it over to the hulking assailant. But the huge man turned out to be a diabetic patient covered in blankets who had gone out for a smoke, lost his way due to failing eyesight, and needed help to make his way back to the hospital. 
 
Nothing in the facts of the situation had changed, but what the medical student saw underwent a transformation. Instead of retreating or defending himself, he was called upon to reach out and help.  Like the mother-in-law, he thought he was seeing one thing, but it turned out that he had been seeing something very different. He just needed to look in a new way, clearly, justly, and lovingly.

What appears to be a struggling and burnt-out profession, a hidebound and money-obsessed hospital, or an inefficient and even wasteful health care system may, on a second look, turn out to be an arena in which the very best humanity has to offer can express itself. A patient who may seem noncompliant, disagreeable, or even hateful may in fact call forth our deepest compassion, if only our eyes are opened.
  
An exercise: Take a person, place, or thing in medicine that you love most. Five minutes a day for a whole week, think about it alone and sincerely wish it well. Then take another that you merely know and do the same thing for another week. Finally, take the person, place, or thing about medicine that most disturbs or angers you and practice sincerely wishing it well. It may not sound like much, but it can change your career and your life.

Good physicians are very observant people, a professional trait taken to the extreme in Arthur Conan Doyle’s portrait of Sherlock Holmes, inspired by one of his medical school professors. But the key to seeing well lies not in attention to detail but in the spirit with which we look at our work and those we work with. By opening our eyes to see clearly, justly, and lovingly, we become better, more fulfilled versions of ourselves, and better doctors to our patients. 
 
Richard Gunderman, MD, PhD, is the chair of the ISMA Wellness Steering Committee.