Wednesday, June 3, 2009

Knowing What Must be Done Does Away with Fear

Rosa Parks in 1964.

Image via Wikipedia

I have learned over the years that when one’s mind is made up, this diminishes fear; knowing what must be done does away with fear

- Rosa Parks

This is another marvelous quote cited in the book I am reading: Iconoclasts, a Neuroscientist Reveals How to Think Differently; by Gregory Berns. The book tries to identify what makes up iconoclasts. Berns defines iconoclasts as people who do things others say cannot be done.

Over multiple chapters, Berns describes the deleterious effects of fear on innovation. Fear not only prevents people from taking action, but can also change their perception. If perceptions are faulty, the actions taken based on these perceptions will most likely be faulty as well.

How does this relate to family medicine?

One of the main types of fear Berns describes in his book is the fear of uncertainty. In practicing family medicine this fear is a fact of life. Rosa Parks states that knowing what to do can diminish fear. I can rephrase this for practicing family medicine:

knowing about most illnesses diminishes fear; knowing clinical approaches for different patients’ presentations go away with fear.

Many family medicine text books and articles do focus on algorithms to approach the problems patients present with. However, if we consider how people (including physicians) actually think, we would end up with slightly different texts. In psychology, people first categorize problems and then devise their decisions and actions based on these categories. Experts categories are different than novice categories. Experts’ categories are more detailed. Here are examples:

  • lay person: Diabetes
  • novice physicians: Diabetes type I, Diabetes type II on oral hypoglycemic and Diabetes type II on insulin
  • experts: young Diabetics on oral hypoglycemic, old diabetes on oral hypoglycemic, diabetics on two injections per day of mixed insulin, diabetics on extended release insulin and a fast acting insulin, and so on.

Having texts and articles that address all these categories is not practical. However, addressing a category level called ‘basic’ is worthwhile. The basic category is the word/category people use when asked: what is this? If I point to a coffee table and ask you to name it: will you say a table ,or a piece of furniture, or a coffee table? If you guessed a table, then you are right. Table is a basic category is this context. Basic categories will differ according to the level of expertise. If a carpenter is asked to name the coffee table; s/he will probably call it a coffee table and not just a table.

Basic categories such as ‘table’ convey enough differentiation compared to the more general category: ‘furniture.’ A table is quite different than a couch which is also furniture. ‘Table’ also has enough specificity when compared to ‘coffee table’. ‘Coffee table’ is more specific, but this added specificity is not always needed. (Lamberts & Shanks 1997)

All experts acquire basic categories naturally; with practice. Experts have mature categories compared to novice. Having text books and articles that address basic categories may speed family physicians’ transition from novices to experts.

At the end -however we classify illnesses-, in family medicine we should focus on patients’ presentations and having well thought of, evidenced based approaches to combat the fear of uncertainty.

Lamberts, K. & Shanks, D., 1997. Knowledge, Concepts, and Categories MIT Press ed., The MIT Press.

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