By Vernon Rowe
Someone asked me the other day why I love Clinical Neurology. The short answer is it gives me immense enjoyment at all levels. The long answer involves the concept of “flow.”
Here’s how: I enter a patient’s exam room with a highly trained nurse. For the next half hour, or hour, or as long as it takes, every ounce of my being is focused on that patient—I notice every twitch of an eyelid, every change in size of a pupil or variation in tenor of their voice. I notice how they breathe and how they sit, how they rise from a chair to walk. Everything.
The world outside that exam room vanishes. Time stands still. I share a portion of the joy and sorrow in that patient’s life. I become a part of their universe, and they of mine. Consciousness of my self disappears, only to return stronger.
The patient knows they’re under a microscope, and the electronic lenses are on. They accept this and give me permission to look as far as need be into their lives to try to help them. For that time I am “in the zone.”
I use tools honed from a lifetime of experience. I am aware of some of those tools, but some of them I am not. (see Kahneman’s Thinking Fast and Slow, and Gladwell’s Blink.) Those tools are always sharpening.
What I’ve just described is an “optimal experience,” so well characterized by Csikszentmihalyi in Flow. This experience is not unique to doctors and other providers who enjoy what they do. It is a general life experience, available to all people, from athletes, artists, writers, and craftsmen, to priests and politicians, to be “in the zone.”
The moral psychologist Jonathan Haidt, in The Happiness Hypothesis, and The Righteous Mind, described the workings of the mind in terms of neuroscience, with the neurotransmitter dopamine and neuro-chemical, modular circuits encoded for behavior as forming the basis of behavior. These circuits have been honed over thousands of generations. As we come to know the brain better, with increasing granularity, other explanations will emerge.
So that’s a very long answer to a very short question. “Flow” is probably the reason why we as human beings do whatever it is we love to do. For healthcare providers, gratitude plays a huge role, but I believe “flow” is the main reason we practice clinical neurology in particular, and medicine in general.
The enjoyment of the practice of medicine is under increasing attack from forces destructive to provider-patient relationships. These forces include an army of overzealous Federal Regulators and an increasing bureaucracy spawned by the federal financing of healthcare, from Medicare to the ACA. And well-intended politicians, hospital administrators, and insurance companies play a role as well.
But as long as some fraction of this “flow” experience can be preserved for doctors, nurses, and other healthcare providers, and those who help us, then patients will have a chance for us to improve the quality of their lives. It is patients who guide us to something we didn’t see before, like the butterfly in Robert Frost’s poem “The Tuft of Flowers.”
“And dreaming as it were, (we) hold brotherly speech
With one whose thought (we) had not hoped to reach.”
For the most part. :)
