The cost of knowledge

[Hippocratic Oath III]

“We are family… ” Profound words from Sister Sledge. Come to think of it, I’m not even sure that she was a real nun…

“To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else.”

It’s about respect. It’s about the transfer of knowledge, of the craft, in an almost Masonic way. That’s what I was doing today – imparting wisdom to trainees on a clinical subject, advice that can’t be written down – it needs to be shared from person to person. Wisdom.

in order to take heed of someone’s wisdom one must respect them. As a person, as a practitioner, as an elder. We don’t start our careers knowing it all, no matter what we think. Humility is required – teachability is required. Can you teach teachability? It requires submission at the feet of the guru, the rabbi, the teacher. Just as our parents teach us to walk, our clinical mentor teaches us to analyse gait.

It’s about partnership. Learning the art of medicine is a joint enterprise, a true apprenticeship. We trail round after our elders for months and years, picking up the scraps of wisdom, copying the traits, the figures of speech, the mannerisms, the bad habits too. But we are part of their team, we are fighting together against the onslaught of death and decay.

It isn’t all plain sailing! Our teachers stumble. Do you remember the day that you realised that your parents were not God? When you realised that they weren’t perfect, and that your disagreements with them on some point or another were valid? I remember the first time that I beat my Dad at badminton – the man who had taught me how to play. It was a solemn moment, but also a moment of jubilation – he was not all-conquering, all-powerful. Now, I was the master [to quote Darth Vader]. Let’s not forget that we are all human. Do we idolise those in authority? Do we look to that senior partner, that consultant, as our deity, without critique and without query? They will fall. They will slip up. One day, they might be on the wrong end of a GMC ruling. What do we do then? Show compassion. They are human. If we forget that our betters are human, we might one day forget that we are human too. Be careful what you aspire to.

Medicine is exclusive. It excludes people who are not ‘family’. You know what I mean. The jokes you crack with your clinical colleagues are not the jokes you crack with your friends. You wear a different hat during the day job than you do outside of work, a different approach. But it is not isolated. You are not on your own. You are part of a brotherhood, or sisterhood, if you like. You share the same vocab, the same in-jokes, the same complaints. There’s an equality there, and a sympathy. But there’s an equity too. You’ve got something? Share it. You know something? Pass it on. You’ve got a great new trick? Tell your colleagues. You’ve just had a disaster? Warn everyone else what not to do. Medical practice is a throbbing network of refining, changing, testing, scrapping, redesigning practices, and from it evolves best practice, and that information has got to be shared. Gratis. Free, as in beer. Because the cost of not doing so is error and suffering.

But we have to want to learn. We have to want to grow in wisdom. Sure, accumulated knowledge is fine. We have to prepared to pay intense attention to wise words, and this goes for medicine as much as the rest of life. I love the overview – I love the ‘Conclusion’, the summary, the aim sentence, the one-line-contraction-of-all-the-useful-bits-that-I-can-glean-from-this-one-hour-rant. But sometimes, I need to follow the flow of the thought. I need to see the to-and-fro of the arguments, to hear all the sides, to weigh up the pros and cons, to see a wiser person’s logic crunching through a problem, to fully appreciate and respect the nature of the answer.  In order to be a watchmaker, you need to know more than how to tell the time.

I have 10 minutes with my patients. Actually, sometimes I have 15 minutes, but I don’t tell them that. They want the answers, the summaries, the bits of paper which will solve their problems. They don’t want the arguments, the processes, the wranglings or the debates. They want simplicity. And I give them simplicity, because I understand their complexity, at least in part. And I am happy to keep that side of the craft veiled, because it is exclusive. Not because it’s glamorous, or scandalous, or magical:

It’s just not very interesting for most people.