Generating the Dots vs. Connecting the Dots

To say that “the future belongs to generalists” betrays an unfortunate truth of modern technological development and scientific inquiry. We have reached a point of dichotomy where the frontiers of research have become the domain of super-specialists. Just publishing a paper now requires extensive understanding of very in-depth phenomena, rather than the type of brilliantly simple science of the superstars that we now look up to such as Maxwell, Bohr, Flemming, and Snow.

However, invention is beginning to slow. Society has matured, and some argue that American society is becoming decadent and repetitive. Marques Brownlee asks if we’ve reached “peak car” in his video. And ultimately, this article continues this discussion. While reaching the peak is not necessarily a bad thing, it does mean that the past few decades represent a transition to innovation.

Innovation is the domain of generalists, Mansharamani summarizes, in an insightful metaphor:

Breadth of perspective and the ability to connect the proverbial dots (the domain of generalists) is likely to be as important as depth of expertise and the ability to generate dots (the domain of specialists).

[. . .]

The skill of generating dots is losing value. The key skill of the future is, well, not quite a skill; it’s an approach, a philosophy, and way of thinking — and it’s critical you adopt it as soon as you’re able.

Vikram Mansharamani

However, there is a lot of nuance involved that precludes a simple black and white understanding. Science will continue to require ever-increasing expertise to remain at the forefront. Even in medicine, healthcare of specific diagnoses is now relegated to specialists.

While the idea of specialization certainly exists in every field, it is especially evident in medicine with the drastic rise in specialists required to treat patients. In fact, I’ve written extensively about the topic. Unfortunately, I’m not sure that an adequate solution exists other than better collaboration and a renewed focus on primary care.

We may take a page from history and embrace the ideals of the “Renaissance Man.” Britannica explains that the “gifted men of the Renaissance sought to develop skills in all areas of knowledge, in physical development, in social accomplishments, and in the arts.” Perhaps this is the way forward.

Dossier

“Harvard lecturer: ‘No specific skill will get you ahead in the future’—but this ‘way of thinking’ will,” by Vikram Mansharamani, June 15, 2020. https://www.cnbc.com/2020/06/15/harvard-yale-researcher-future-success-is-not-a-specific-skill-its-a-type-of-thinking.html

“Jack of All Trades,” by Sahil Nawab, May 31, 2019. http://www.sahilnawab.com/blog/jack-of-all-trades/

What Storytellers Have in Common

Storytelling is something that is shared across the human experience. All of us have been inspired, or awed, or frightened, or intrigued by stories. There is one thing that storytellers have in common—an incredible imagination.

They allow their thoughts to wander, and importantly they are able to capture them for the future. This ability lets them develop them later, to dream and dream with such fidelity that they resonate across the human experience. These are the most powerful storytellers.

For me, the magic of cinema is a result of the balance between the artistic and the technical. You have to tell a powerful story, but breathe life into it the through actors and actresses, lights and cameras, sets and visual effects, music and sound. You have to use those tools to make something powerful to humans, and that requires and understanding of people. You need to be aware of how people think, how they make connections

When these things come together, cinema can be transformative. It allows us to wield the power of emotion.

How Stories in Medicine Connect Us

Note: This article was originally published as part of the Q4 2019 issue of the WFCC Newsletter and is reproduced here with permission. See original: http://www.sahilnawab.com/wfcc/q2_2020.pdf

We are often confronted with tragedies throughout the world that are challenging to comprehend. The abstraction of such adversity presents an often insurmountable obstacle to action. Elizabeth Dunn, a researcher studying the science of giving and happiness, asks, “if any of us had been asked to donate 15 hours a month to help out with the refugee crisis, we probably would have said no.” But, she explains, when people can “easily envision the difference they [are] making” and feel “a real sense of connection,” they are much more willing to help.

Cultivating a meaningful connection between members of society allows us to work together to address challenges that can sometimes feel overwhelming, such as the social determinants of health that affect the uninsured and underinsured patients coming in to the free medical programs. The volunteers are uniquely positioned to see the impact that their work has on the lives of patients. Part of their role is to listen to the stories of the patients that walk in. They engage with patients and are deeply embedded in the community.

However, this doesn’t translate particularly well to those on the outside. The hurdles that patients face are not easy to understand from a perspective of privilege. The vast majority of Americans will not be disenfranchised from the healthcare system. They will not face the difficult decision of forgoing medicine or treatment for food on the table, a roof over their heads, or books for their children. Yet, their contributions, whether through donations, volunteerism, or subsidized services for patients, are essential.

Often, we fall into the trap of thinking of charity as something that we have a moral obligation to do. But we should not forget the incredible joy that comes from helping others. This is especially true if we do it, as Dunn notes, by creating opportunities to “appreciate our shared humanity.” This appeal is reinforced through millions of years of evolutionary biology, as human society was built on foundations of collaboration and cooperation. We find happiness in helping one another and the human brain is highly attuned to the personal connection that comes as a result. Here, Canadian writer Marshall McLuhan’s suggestion is apt, our medium, volunteering and working to reduce the healthcare burden among the most vulnerable, truly is our message.

Medicine, and especially the work of free clinics, lies at the intersection of science and humanity. Science is built on logic and observation, which have proven to be powerful tools to improve our understanding of the world around us. However, to most people, data and statistics are nothing more than abstractions that are difficult to relate to. Recognizing our own humanity allows us to wield the incredible power of stories to move people to tackle complex and nuanced issues.

As medicine continues to evolve, a new philosophy that embraces stories is taking hold in opposition to the impersonal style of medicine that has become increasingly common throughout the United States. Narrative medicine, championed by Dr. Rita Charon at Columbia University and Dr. Lisa Sanders who writes regularly for the New York Times, invites physicians to think of listening to patient stories like reading a mystery novel. While this concept may sound strange at first, there are many parallels that solidify her argument. For example, Charon argues, “‘You have to be so present, so alert, with your curiosity so intact [and] you have to assume that the narrators are going to mislead you. When a patient tells you what happened, you’re going to hear the opposite story from their mother or neighbor.’ Doctors, like readers, have to take in all the different narratives and resist the urge to immediately say which is right with premature certainty.”

This approach requires time, something that can be hard to come by in modern primary care offices and emergency departments. Instead of spending time with patients, doctors often must deal with excessive administrative work, much to their chagrin. Dr. Atul Gawande argues that dealing with insurance, billing, and inputting patient records are a big cause of physician burnout. He backs his argument with a 2016 study that found physicians spend two hours on the computer for every hour with patients. The volunteers at each of the free medical programs take pride in the fact that they can take the time to listen deeply to patient stories and it’s an important part of their work.

Listening to these stories helps to hone awareness to a greater Truth, one that requires interpretation and careful judgement. The stories of patients help paint a picture of society where certain communities are disenfranchised and have disproportionate struggles to access quality healthcare. They highlight the importance of the work that the free medical programs do and are an incredibly powerful tool to bring people together to effect change.

The importance of stories is twofold: (1) listening to patient stories is a big part of the free medical programs and narrative medicine can improve patient care and (2) stories can be used to move people to take action in a way that data and statistics cannot.

Dunn points to an example where two charities in similar lines of work, UNICEF and Spread the Net, exhibited completely different responses when people donated the same amount. Most people might think, she argues, that UNICEF is so broad that a small donation probably won’t make a big difference. Spread the Net, however, offers “a concrete promise: for every 10 dollars donated, they provide one bed net to protect a child from malaria.” She found that people are happier when they give to organizations, like Spread the Net, where they can easily envision the difference that their contributions will make.

This subtle contrast makes a big impact for organizations. Based on her research, Dunn specifically advises organizations to reward donors and contributors with “the opportunity to see the specific impact that their generosity is having.” In this regard, the free medical programs have a powerful tool to wield: the stories of the community. This must be done carefully, of course, out of respect for patient privacy. But the stories of patients are consistently a big reason why the volunteers continue to do their work. The volunteers feel a real sense of connection with the community and with the individual patients that they speak to. When done well, stories can become a major driving factor of change.

We would love to hear your ideas and suggestions to demonstrate the impact of the free medical programs on our community. Please send any comments to worcesterfreeclinics@gmail.com.

Dossier

“Helping Others Makes Us Happier — But It Matters How We Do It,” by Elizabeth Dunn, April 2019. https://www.ted.com/talks/elizabeth_dunn_helping_others_makes_us_happier_but_it_matters_how_we_do_it

In this TED talk, Elizabeth Dunn discusses her research showing that personal connections when giving make a big impact on our happiness and discusses her own experiences with sponsoring a Syrian family in Canada.

“This Doctor is Taking Aim at Our Broken Medical System, One Story at a Time,” by Sigal Samual, March 5, 2020. https://www.vox.com/the-highlight/2020/2/27/21152916/rita-charon-narrative-medicine-health-care

Dr. Rita Charon is a pioneer of narrative medicine, an approach to medicine that likens seeing patients to reading novels. She emphasizes how listening to patient stories in this way can make medicine better for patients and physicians alike.

“Why Doctors Hate Their Computers,” by Atul Gawande, November 5, 2018. https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers

This article examines how, despite their utility, electronic medical records can often be a hindrance to patient care and contribute to physician burnout.

Classroom Ants

Note: this is a piece of fiction that I wrote for a project.

Every few days the brewery received complaints from the tenants next door. One day it was the ants all over the floor, seeping out from under the shared wall and disturbing the frightened third grade teachers and her squeamish students. As the evening wore on, a few fifth grade boys thought it would be funny to leave squashed ants all over the floor, hoping to hear the childish screams of the next class of sixth graders as they walked down the almost painfully bright hallway towards the packed waiting room.

Almost seven, it was just past rush hour. A line of cars backed out into the parking lot of the brewery next door, adding fuel to the daily battle between the two tenants. The setting sun streamed through the glass walls of the waiting room, and the students bustled about trying to get a good view out the windows to look for their parents’ cars.

One of the fifth graders opened the door to the waiting room and stood aside to let the others through. She looked outside, but the hard glare made it difficult to see easily. She glanced at her phone, hoping to see an unread notification from her mom who was supposed to pick her up. Alas, nothing. And so, her mind wandered, her gaze flitted about from face to face at her peers laughing at each other’s jokes, discussing their antics from the class. Two friends stood in the corner near the sign in window, intently discussing a problem that stumped them earlier in the day. She noticed a small ant, crawling near their feet. It wandered, looking for something to eat. A few others followed, making a distinct line.

Even more followed, and she noticed that they seemed to be coming from a small gap between the wall and the tiled linoleum floor. Amidst the commotion of the waiting room, she barely noticed the sweet smell from the brewery. It seemed that everyone had gotten used to it, but looking at the ants made her more aware of its particular odor. It seemed familiar to her, reminding her of the small gatherings her parents often held with friends, often late into the night.

Next door, the sweetness was far more pungent. The warm glow of the brewery lights spilled over onto the sidewalk right outside, complementing the rapidly waning sun and the deep purple sky. The glass walls overlooking the same parking lot were covered in condensation. A result of the brewery keeping their humidity and temperature just high enough for the yeast to be comfortable. The distilleries hummed in the background, so the employee giving the tour spoke loudly at the visitors. As the tour made their way towards the distilleries, a couple towards the back whispered to one another.

The husband seemed meek at first glance, his hands placed firmly in his pockets. His dress was odd, with well-worn jeans, but a collared shirt neatly tucked in. His appearance belied his deep expertise in the brewing process. As he joked with the others in the group, his wife smiled, and though quiet, she had an air of mischievousness about her. In the heat of the brewery, she unzipped her company jacket, clearly emblazoned with the logo of the pharmaceutical company with offices and labs just up the street. They both had just arrived after work, passing by the bridge and a Starbucks that had recently opened up.

Earlier that day, both were working in the lab on an experimental biologic that could degrade membrane-spanning receptors. It was accidentally discovered a few years ago in the adjacent building by a group of chemical engineers working on increasing production rates of the company’s bioreactors. The engineered yeast cells expressed a chimeric antigen on their surface, patented by the company. This was used to help degrade the yeast quickly and extract the biologic, but without adding surfactants or other contaminating chemicals. Their system used hijacked chimpanzee macrophages to quickly destroy the yeast cells by phagocytosis, but it seemed that it was working too well. . . .