As physicians, we consider ourselves highly intelligent people. We got good grades in high school and college, we studied hard, and we continue to work hard in our jobs and careers. If someone told us the world is made of smart people and average people, we would likely all feel good about considering ourselves to be in that smart category of people who are well above average.
I have long lost my regard for the word “smart” after reading Carol Dweck’s book, “The Growth Mindset,” which completely transformed how I think about our abilities and qualities. According to Dweck, being “smart” and “intelligent” are simply labels that people may become fearful of losing, rather than accomplishing possibilities with patience, practice, and believing that personal qualities may be acquired. A valuable attribute of an engaged, active, and evolving individual is one’s creativity.
Are physicians creative? Creativity is usually used in an artistic context, and in conjunction with being inventive, innovative, original, and individual. Although we might all agree that physicians may be hard-workers and learned individuals in their craft, they are not viewed as a creative segment of society, or even as “movers and shakers.” Recently, a non-physician female friend of mine who married a financier confided to me that she would never have wanted to date a doctor because they are “just so boring.”
If we have nobly dedicated ourselves to humankind by saving lives and eliminating disease, how did we get so uncreative and boring? There are three main reasons: 1) how we train; 2) how we practice; 3) how we identify.
How We Train
Once a person starts medical school, the path for the following decade is largely predetermined, other than having to choose a medical specialty. The work is similar, but the location of the training may differ if the trainee moves to different university institution. For year after year, all you have to do is show up and work hard — diligence, effort, and a positive “yes” attitude count more than intelligence or original ideas. A fellow working with me told me that he chose medicine because it made sense to do something practical with the science he had enjoyed. Going into medicine was the better choice than going on to a higher post-graduate degree with less job security at the end. He felt that his path to becoming a physician was “the one of least resistance.”
So perhaps medicine self-selects for people who want predictability and stability, people who are inherently uncreative. During the course of training, there may be undeniably emotional and clinical experiences, which contribute to growth in compassion and human connection, critically important human attributes. But without facing significant situational unpredictability and similar challenges, there may be little opportunity to exercise our creative brain muscles. Working on the wards, signing charts, and memorizing patient stats for rounds may not result in creative growth and development. This is because of how we practice.
How We Practice
Once we see the end of this arduous training decade in sight, most physicians are so overjoyed and exhausted at coming to the finish line that they are not terribly thoughtful or creative in choosing a practice setting. We just want to know where to sign when a job offer comes through. The trend for physicians who complete their training has been to join a group practice. With shared resources, first-year guarantee income or other payment arrangements to reduce financial risk, more control of working hours, fewer physicians start their own solo practices. Health organizations have become highly desirable employment options. Most things are taken care of for you, much like it was during training. You just have to arrive in clinic and see the patients.
It has been ingrained into us that being a busy doctor and seeing many patients is the epitome of clinical success. So we strive for this. Having learned how to diagnose disease and treat patients, the new practicing physician will seek to become as busy as possible. Being busy does not necessarily require much creativity, however.
So for many physicians, starting practice may not be too terribly different from training. Where are the opportunities to practice creativity? Certainly not to be found in the day-to-day life of being a physician.
How We Identify
If you see yourself as primarily a physician, you may never consider making more time in your life to explore other passions or interests. Many physicians feel that they have an obligation to continue to work hard, to be the person that they have always been (and have only ever known), a hard worker who faithfully shows up to work through the patient list.
Physicians may not have the mental space available for thinking of new things to add to their lives. It may actually be much easier to just be busy, to not think, to work hard, and not be consciously aware of considering “creativity” to be a quality to development.
I’m Not Creative – How Do I Change That?
Being creative involves seeing yourself — your situation, your direction, your purpose in life — in an atypical way. Yet, the path of the physician is so absolutely typical and predictable. However, there are times when we do decide to take a different path, when we can see an original solution to something that bothers us or is a challenge.
Exercising creativity, first and foremost, is important for your patients. When something just doesn’t fit, when a person has a symptom that seems to have no particular cause, reaching into one’s bag of creative options can solve the mystery.
For example, a young woman was referred to me for management of an ocular melanoma. Despite having a dome-shaped, elevated pigmented lesion with retinal detachment and decreased vision, the clinical appearance just didn’t look right. I began to ask her more questions and learned that she also had occasional eye pain, and that her symptoms began when her brother was recently injured in a near fatal car accident. Because of the stressful onset, I treated her for posterior scleritis, an idiopathic inflammation that can sometimes simulate a neoplasm. Her condition resolved entirely. When faced with an unusual surgical challenge, such as removing an oddly shaped intraocular foreign body from the eye, creativity (and experience) is critical when deciding which tools to use that will cause the least damage.
There are parts of the practice of medicine based on traditions and habit, rather than actual evidence. For example, giving topical antibiotics to patients after eye surgery has never been proven to reduce postoperative infections. Yet nearly all ophthalmologists do it. Creativity will help you question “traditional practices” that are not evidence-based. In my own practice of treating ocular tumors, when almost every one of your treated ocular melanoma patients has poor vision, it is easy to feel this is just the norm in a tumor eye. However, creativity allowed us to perceive this as unacceptable rather than the norm, and innovate a way to shield the healthy tissues of the eye to prevent radiation damage during treatment, greatly improving the standard of care practice of radiation therapy.
Being creative, furthermore, is important for yourself. When you become open to other possibilities, the practice of medicine – taking care of patients, how you run your practice, how you fit it all together – becomes more fun, enjoyable, and meaningful. You are not following a pattern, or a predetermined career or life trajectory. You become able to allow yourself to have different and purposeful experiences that may be important to you, that a typical physician may not follow.
Like anything, creativity can be learned. Opportunities are everywhere. Talk to that parent who is in an entirely different line of work. Find out what your technicians do in their spare time. Take a writing class; learn to express yourself through painting; learn to play an instrument. Volunteer. Teach in activities that are unrelated to your everyday career. Say to yourself, yes I want to work on my neglected creative side and just do things where you have absolutely no experience, but have an interest in and can learn. Put yourself out there in the world and experience something different. Pick something you might have considered briefly, but then dismissed.
Even within their own fields, many medical specialists strongly resist change. If there is a new technique or procedure that potentially can drastically improve outcomes, many physicians will spend their efforts and energy writing articles refuting it, rather than just giving it a try and switching gears.
Don’t always take the path of least resistance. Create your own path. Be honest with yourself: What do you like about your career, and what do you hate? Change it! You will become stronger and more creative because of it. Your patients and you will benefit.
Dr. Tara McCannel is a vitreoretinal surgeon and ocular oncologist. She likes teaching, running with other moms, and family getaways. Dr. McCannel is a 2019-2020 Doximity Fellow.