An excerpt from From Hurting to Healing: Delivering Love to Medicine and Healthcare.
Before we speak
Many people enter a conversation with preconceived ideas of how it will go. We constantly make assumptions, and our brains often jump to conclusions based on experience, previous interactions with a particular person, our current emotional state, and our own agenda and aspirations. Sometimes, our interactions may be influenced by feelings of arrogance, contempt, or bravado, while other conversations may be constrained and tentative due to feelings of anxiety, fear, or uncertainty.
A discussion can serve many functions, but two of the most important are the exchange of information and the development of a more trusting and mutually beneficial relationship. However, in some organizations and interpersonal interactions, information can be seen as a currency of power. In a poor culture, data and information may be protected and withheld, used to further one’s own aims, or to hinder the progress of others. Connections will not thrive in such an unhelpful scenario.
Furthermore, within any conversation, a sense of not being listened to or valued will hinder a relationship. Without mutual respect, the relationship cannot become trusting and supportive. Often, these poor communication characteristics will play out repeatedly. The elements of poor interaction can even manifest before the conversation begins. After such exchanges, both people will leave with their negative assessments of each other reinforced.
In the New Testament, Jesus is quoted as saying, “It is easier for a camel to pass through the eye of a needle than for a rich man to enter the kingdom of God” (Matthew 19:24). This metaphor has generated much discussion. It has been claimed that there was a small side gate into the walled city of Jerusalem that allowed access and entry at night when the main gates were closed. This small gate was known as ‘the eye of the needle’ due to its size. For a loaded camel to enter, it would need to have its packs removed and stoop down, essentially losing its baggage. Only the wealthy would own a loaded camel. Therefore, for a rich or proud person to reach ‘the kingdom of God,’ they would need to ‘lose their baggage.’ This presumably meant casting off arrogance, hubris, self-pride, and preconceived attitudes and becoming humble.
A similar situation exists with communication. To achieve truly worthwhile interactions, we need to cast off our preconceptions, already-formed opinions, and attitudes. We need to enter the conversation with curiosity, prepared to learn, and ready to share. This benefits both participants because we can’t learn without listening and hearing other views. As Irish playwright George Bernard Shaw said:
“If you have an apple and I have an apple, and we exchange them, we still each have an apple. If you have an idea and I have an idea, and we exchange them, then we each now have two ideas.”
Medicine is a very conservative profession, and there is occasional reluctance to accommodate new ways. This resistance can result in attitudes that quickly end discussions about innovative ideas. Some skepticism is entirely appropriate as unproven techniques should not be embraced too quickly, as hasty adoption could lead to patient harm. On the flip side, the system can become staid and resistant to change, creating a conservative wall of pride and arrogance. In some cases, those who see things differently can face ostracism by the establishment.
Barry Marshall was a medical registrar when he, together with pathologist J. Robin Warren, became interested in stomach biopsy specimens from patients with peptic ulcers. These specimens also identified bacteria in the biopsies. At that time, the cause of peptic ulcers was universally thought to be due to stress and associated with lifestyle factors such as smoking and spicy food. It was taken for granted that the acidity of the stomach would kill all bacteria, so the organisms identified in the biopsy specimens were considered contaminants according to the prevailing view.
However, Marshall and Warren became convinced that the cause of ulcers was related to the organism they had isolated. Marshall’s theories were met with ridicule by the medical establishment, which continued to treat patients with long-term medications to reduce stomach acid. Marshall’s career suffered, and he endured public ridicule. Eventually, he conducted an experiment on himself, inducing his own peptic ulcer by drinking a culture of the organism (subsequently named Helicobacter pylori) and then successfully treating himself with antibiotics instead of antacids. After years of opposition to his ideas in Australia, Marshall set up a laboratory in the US. Today, standard treatment of peptic ulcers throughout the world involves microbiological culture and treatment for Helicobacter. In 2005, Marshall and Warren were awarded the Nobel Prize.
As a medical student in the 1980s and a hospital resident doctor in the early 1990s, I recall the scorn with which Marshall was spoken about by consultants in the tea rooms of operating theaters. How dare Marshall challenge the accepted wisdom of the establishment? Due to the attitudes of my senior colleagues, whom I assumed to be all-knowing, I developed an opinion that Marshall must indeed be a crackpot, despite not having analyzed his research myself or even having a full understanding of the arguments.
A personal lesson that I take away from this is the great influence, even when unspoken and unconscious, that senior colleagues have over less experienced staff. The medical profession that didn’t listen and was too proud to consider new ideas reinforced these attitudes in junior doctors. The resistance to listening and the arrogance in assuming that what was taught was indisputable were poor examples of communication and culture. Experienced doctors allowed a lack of personal humility to hinder wider understanding of the true pathogenesis of medical conditions, delaying effective treatment for many people. This inability to overcome entrenched attitudes before entering a conversation can inhibit innovation. Without mutual positive regard, effective exchange of ideas can’t take place. And unless we listen and remain curious, we will never learn anything new. To move through the barrier to a more informed and better way, we must first shed our baggage.
Simon Craig is an obstetrician-gynecologist in Australia and author of From Hurting to Healing: Delivering Love to Medicine and Healthcare.