Credentialed or Inquisitive

(Image from Not Your Typical Wrist Pain at EMCurious)

On Monday I got to have a long visit at an outdoor café with a friend. She’s an expat from Germany. I’m an expat from the USA. We see things differently from most Britons and differently from each other, but we hold something in common at our core. She comes closer to being able to describe it than I can. We both appreciate it.

We don’t see or speak with each other often, so we had a lot to talk about. Business, life changes, things happening around us.

Today I’m thinking about our discussion of credentials versus a nature that is inquisitive, never finished with learning or growing, always questioning and exploring and pondering. I’ve written about needing to know about more than certificates, diplomas and certifications to get people into the work roles that will make the best use of their capabilities. That’s a dry way to put it, though, and doesn’t touch how it translates to our own lives.

You got a hint of that translation with the story of the solar power system at our house. Remember, only one bidder really looked at everything about the property. He asked more questions. He got into more of a discussion about our goals and wants. Everyone else had a canned set of solutions based on minimal information.

With my friend, we got into a deeper, clearer example.

I told her what I’ve learned about choosing my doctors.

Board Certifications and Tunnel Vision

Decades ago, I got a sinus infection that took a year and a half to vanquish. It took multiple rounds of antibiotics, an off-label nasal spray regimen, a rigorous infection control protocol at home, and eventually replacement of my silver fillings.

Silver amalgam leaches tiny amounts of mercury into the body. Mercury is toxic. Among other things, it damages the immune system. Usually the amount from silver fillings is too miniscule to matter. For me, replacing the fillings with polymer and taking one more round of antibiotic did the trick. That was my idea. We did it at my insistence. My doctor and dentist didn’t want to do it. (Note: This doesn’t mean you should panic if you have silver fillings. It’s highly unusual for them to make such a difference. It happens that they did for me, perhaps because one filling turned out to be disintegrating underneath where no one could see.)

Hardly anyone gets through life without ever getting sick or hurt. The next time I got really sick for a good while, it was more perplexing. By then I lived not far from Johns Hopkins, so I went there. I got booked in with specialists in two fields that seemed pertinent. When I looked them up at the library, both men held multiple top notch credentials in their field. One was board certified in three demanding specialties. I thought surely they could figure out what I needed.

Each made up his mind before I even walked into the examination room that my diagnosis would be depression. Each ignored anything in my symptoms that didn’t fit depression. A GP had already tried treating me with antidepressants, and they not only didn’t help, they made me unable to cope with anything. (Needless to say, we had to stop that treatment quickly.) When I tried to bring up these discrepancies, they talked over me and shut me down. They, with their lofty credentials, knew everything already.

They each ordered some tests. I went through those tests, but it was abundantly clear that they only ordered tests to appease me and perhaps pad the bill.

This was nothing special. It happens to women frequently. Whatever is wrong with us, if it isn’t something as obvious as a broken arm, we’re depressed. Come to think of it, just a few years earlier a colleague’s wife broke her arm. The emergency room completely missed it, sending her home with painkillers and a diagnosis of bruises. Maybe our problem has to be more blindingly obvious than a broken arm to be diagnosed as more than just in our minds.

Fewer Credentials and Phenomenal Care

The next physician I tried was Dr. Janet Horn. She exited from private practice about 20 years ago, although she has continued to be involved in medical care. She practiced in Baltimore, Maryland, at both Sinai where I first saw her and Johns Hopkins. By that time, if I had realized she had any affiliation with Johns Hopkins, I wouldn’t have seen her because the doctors there had “lost” my file with its absurd misdiagnosis. (My file there is still “lost” to this day.) Failing to meet Dr. Horn would have been a terrible loss.

Dr. Horn didn’t pretend to know everything. As we got to know each other better over the years and she moved into her own private practice outside the hospitals, she talked about becoming a doctor as AIDS burgeoned. She understood that she couldn’t cure her AIDS patients. They would all die. But she could do her best to help them have the best life possible in the time they had left. At the time, nobody could tell her how to do it. She had to figure it out, and she was determined to do so. “Please don’t take this wrong, but it was a fascinating time” to be going through her internship and residency.

She didn’t have board certification in three elite specialties. She didn’t know right away what to do for each patient who came to her. But she was endlessly inquisitive, approaching each case as a unique puzzle, not something she could conquer with one magic treatment, a multifaceted problem that would need to be chipped away at one piece at a time. She spoke with each patient at the highest level the patient could understand, no higher and no lower. Passing me in the hallway as she went to one examination room and I was on my way to the one where she would see me, she would say over her shoulder, “Have you read the study on…” some topic we were both interested in, yet she never resorted to medical shorthand to discuss her thoughts and treatment decisions.

She became one of the leading clinicians in the USA for patients with AIDS and the almost-parallel epidemic of CFS. Once, in her waiting room ahead of an appointment, one of her AIDS patients emerged from the examination and treatment areas. He was clearly nearing end stage, thin, pale, exhausted, dazed, barely able to stand and take small shuffling steps. He looked up suddenly and burst out to everyone waiting, “Isn’t she wonderful?!”

Yes, she is.

Although I don’t have AIDS, her puzzle-solving approach resonated with me. We applied it to everything. Normally, when people “went to the doctor for a full physical” in the USA, it was up to a 90 minute appointment. (Health care doesn’t allow such extravagance any more.) The doctor ran a bunch of tests, did some poking and prodding, and decided whether you were healthy or needed follow-up.

We didn’t do it that way. About every other year, I went to Baltimore for my “full physical.” We started with an appointment of no more than 30 minutes, often much less. She caught up with how I was doing in general and anything I had noticed that seemed unusual. She ordered some tests. I went away to get samples or scans done.

Test results went to her. She looked at them and if anything seemed to need a closer look, she ordered a few more.

We did three or four rounds of this over the course of a week to a week and a half. Then I returned for another short appointment for all the test results and the verdict.

Once, this led to further tests every few months over the course of 2 ½ years, tracking down the source of two vague symptoms that might be inconsequential or might be subtle signs of cancer. In the end we found a small polyp in a hard-to-find spot and removed it just as it was beginning to change. With more time it probably would have become malignant. Because of Dr. Horn, it never became more than a minor anomaly.

Across the Range

When I say credentials aren’t everything, I don’t just mean in terms of what work roles people should hold, or how pay and promotions should be determined. It’s applicable across the range, from high level officials to low level workers, in volunteer groups, choosing who to engage to do something for you. The impact can be intensely personal.

Enough credentials, enough training and knowledge to have a good foundation… Yes, we need that.

But credentials aren’t worth much without the gut sense of always having more to learn. Credentials by themselves can become blinders that restrict what we can see and how we think. Given a choice between the highly credentialed and the less credentialed but highly inquisitive and driven, I prefer the latter every time.