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Gretchen: Creativity matters in medicine. Find out why, next on The Scope.

Announcer: These are the conversations happening inside health care that are going to transform health care. The Health Care Insider is on The Scope.

This is Gretchen Case from the division of Medical Ethics and Humanities, and I'm speaking with Jay Baruch. Dr. Baruch is an Associate Professor of Emergency Medicine at the Alpert Medical School at Brown Ï㽶ÊÓƵ, and he also serves as the Director of Medical Humanities and Bio-ethics Scholarly Concentration there at Brown. What we're going to be talking about today is creativity in medicine. Tell me why creativity matters in a field that we often think about as based on science, based on evidence. Where does creativity matter in medicine, and why?

Dr. Baruch: Well, first off, I will just say that evidence does matter, and knowledge matters, and facts matter, and we need to know things. But, the truth of the matter, there's so many different problems that we face in the care of patients that don't come prepackaged with easy solutions. Sometimes the answer, unlike medical education, the answer sometimes isn't A, B, C, or D. It's none of them.

And sometimes the biggest challenge is, like, trying to learn how to ask the right questions, and to be open to the possibilities of what might be going on, because we take care of patients, and these patients are human beings, and no two patients are really ever the same. Even if you had two people with chest pain, two people with belly pain, your mind's going to work very, very differently, depending upon not just their symptoms but the other issues that are at play, which, oftentimes, are as important if not more important than the medical stuff that we glom onto.

Gretchen: And how do you think, in particular, your work as an ER physician has called you to think more about creativity, and to teach more about creativity?

Dr. Baruch: Well, first off, the question becomes, like, what do you mean by creativity? It's just a tough thing to, sort of, dissect because there's a zillion definitions for creativity. Or, maybe not a zillion, but there's a lot. And so, how I like to look at it is from the perspective of, like, how does creativity manifest itself in, sort of, clinical practice? There's many ways it operates. And that gives you, I think, a little bit more of a handle on what we mean by it, because it becomes more personal.

So how I look at creativity as, sort of, thinking divergently, when a patient comes in with a particular set of complaints or issues, I think openly as much as possible to be . . . to create possibilities, to ask different types of questions before, sort of winnowing down, trying to have an answer. Creativity involves sort of trying to make connections between disparate ideas. Even if we think about, sort of, innovation, oftentimes we're not creating something new but we're taking two dissimilar things and we're seeing if there's connections. And that functions in the bedside, too, in the care that we have of patients, because sometimes there are so many different things going on and to be open to the fact that there are other elements at play.

Creativity also acknowledges the importance of taking risks, you know, that patients sometimes don't want to hear, like, the rote response. Every end-of-life conversation can be very, very different, depending upon the stories, the situations, the relationships. The family encounters the saddest of their relationships. You have to be able to, sort of, be able to adapt and take some risks. And some families are going to want more direct approach. Some people, "I don't want to know," a hands-off approach. Some people are going to, sort of, want to have all the facts, they want more direction. Other people just need time, and they're not ready for that conversation.

But, at some point, you have to be able to sort of . . . willing to take risks, and that risk-taking is at a very human level. It's the same risk that we sort of take when we just meet people on the street, or we meet people at parties, and we have conversations. They're normal conversations. We seem to forget the fact that we're so scared sometimes of saying the wrong thing that we're not willing to come out of ourselves to, sort of, really try to connect. So to be able to take risks at a very human level in how we engage with patients.

And it also involves maintaining our personality and maintaining our personal physician voice, which sometimes is lost if, perhaps, we get taught that there's a certain script that you need to follow. So to be able to have that courage and that bravery to sort of come off-script.

And, lastly, I think, it's to recognize that sometimes we'll fail. There's this tension at play where people in medicine, physicians are often criticized for being less human. We want our doctor to be more human. But, at the same time, we don't want to recognize that humans will make mistakes, and we're fallible. And that's a really tough place to negotiate when you're a younger doctor, I think. I'm still struggling with that as an older doctor. So, you know, the ability to make connections, to think divergently, to be able to take risks, and to recognize that failure is sometimes part of this process, that's very, very complex, on many, many different levels.

Gretchen: So what would you say to someone who says, "I'm not creative"? And I'm thinking of a scientist in the lab, I'm thinking of a medical student in their first or second year. I'm thinking of an advanced physician who you say, "Creativity is important," and they say, "I'm not creative."

Dr. Baruch: One line would be, "Everyone's creative." That's it, and that's not from me, it's from designers who have talked about this, about people population of individuals in general. But I think the problem is that when we think about creativity, we think about, sort of, artistic creativity. And, you know, someone might not envision themselves a writer. However, they can become a better writer than they actually are. And there have been so many times when I've had students or fellow colleagues who have said, "I don't write. I'm not creative, I don't write" and they are stunningly good writers.

So my first response to those people is, one, everyone can be creative. Secondly, don't make the mistake of thinking about creativity in what we do, and tie that, tether that, to artistic creativity, because they're different things. People will be good at different tasks, regardless of what you do, whether it's creative or not. So the fact that you're not a good musician, you don't envision yourself a writer, or you can't draw, or, "I can't dance," doesn't mean you're not creative, it just means that, perhaps, those are things that do not come naturally to you, that you have not pursued.

Creativity also involves a certain measure of vulnerability. And, as you know, my body does not move gracefully in space, and so I tend to avoid those situations that involve me moving gracefully in space. And am I as bad as I think I am? Maybe, maybe not. But, what's always at play is the vulnerability involved to say, "I'm not so good at this. I look silly." So the ability and the willingness to, like, "I'm going to be silly," it's okay to be silly, you know, because that's the only way I can allow my vulnerabilities to, sort of, emerge and surface.

And that becomes really important, because there's so much vulnerability that's experienced and felt by our patients that we don't always recognize, that it's really hard to sit down and tell us something that is really profound, that it's something that you're very scared of, very fearful of. That can be hard, even if it's someone that you know well. It's an emotional place that is tough to describe and that you really need to . . . I think students really need to just feel it themselves to, perhaps, have a better insight into what their patients are going through when they're telling them information.

Gretchen: I think that's probably a good lesson, not just for early learners, students, but throughout your career, throughout anyone's career, to remember to stop and take those risks, even if you think you're an expert or even if you think you know in which ways you are creative or you're not.

Dr. Baruch: And it's really easy. So I'm trying to think about people who might be out there. It's really easy to take risks. Say, "Okay, we need to take more risks." Take more risks. However, if you think about it, usually the best-dressed people in the hospital are the people who are in risk management. Right?

So, on one hand, I don't want to give the wrong impression that there are, you know, efforts to, sort of, have replicable models, and to reduce medical error and reduce mistakes, and to improve systems. Those are important. We're not saying we don't want chaos in the hospitals. We don't want people to say, "We're going to try this to prevent our patients from falling." That's not what we're talking about.

But when you live in an environment where risk, with a capital "R," is an ever-present place in hospital systems, sometimes it can be very difficult to get people to understand what that, sort of . . . what we mean by the little "r," the little risk we want you take at the bedside, the emotional risk that, perhaps, we want the students to take, or perhaps patients want from us, from their providers.

Gretchen: So we've been talking about creativity in medicine and, actually, one of the things that we talked about this morning is, what do you want people to go away thinking about when they're thinking about creativity in medicine?

Dr. Baruch: I would say the following. First off, medicine is inherently a creative act. It's fraught with uncertainty and ambiguity, and we have to recognize that. And people who are quite expert in trafficking, in those sort of liminal spaces, those spaces of . . . those white spaces, are artists, you know, artists of all stripes whether it's writers, designers, visual artists, whoever, and there's a great . . . I think there's a great opportunity for medicine of the future to expand its concept of who should be part of the health care team, or the educational team at medical schools, and that there is a place for artists in that. And I think there's a necessary place for artists in that.

By taking advantage of their ability to think differently about what we're doing, it gives us an opportunity to reflect upon the processes that we've sort of latched on to in the past, and adjust, and make plans for a future where, I think, the challenges that we're all going to be facing are going to be new and interesting and profound, and are going to affect our communities in deep ways. And they're going to expect us, as health care providers, to be able to respond to their experiences in a meaningful way.

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