Zen and the art of pediatric practice

The picture shows Robert Pirsig and his son on the motorcycle trip that figured in his classic meditation about quality, Zen and the Art of Motorcycle Maintenance (1974). A wonderful recent editorial by Perri Klass in the New England Journal of Medicine, has the referential title “Zen and the art of pediatric health maintenance.” (The full editorial may be behind a paywall — if anybody wants a copy let me know.) Her essay is a riff on Pirsig’s pursuit of Quality.

The point is that it is a very, very difficult thing for a doctor to be completely centered in the moment when talking to a family about their child’s medical problem. It is similarly difficult when another person, say a medical student or a resident is describing the patient to you. It’s easy to skip ahead in your mind when you hear things, for example, jumping ahead to what tests the child might need or what to do next. I’ve certainly found myself listening somewhat distantly to a story, only to be yanked back to the moment by some trigger statement, as in: “Pardon me, Mrs. Jones, but he did what?” The hurried and harried aspects of today’s practice environment makes this especially hard: it’s difficult not to be thinking of the next task.

Taking a medical history is a conversation, and all of us have this sort of thing happen to us in usual conversations, especially if we are talking to someone who tends to ramble and circle around the point. We tune them out. So among many of the challenges of practicing medicine, really putting all else out of your mind and listening is something doctors struggle with every day. The good ones learn how to do it well.

That great sage of medicine, William Osler, is well known for his aphorisms. One of them is: “Listen to the patient — he is telling you the diagnosis.” Or, as Dr. Klass puts it:

So zen and the art of health care maintenance: it’s being there in the exam room, in the moment — clearing away the noise of yourself so you can look with eyes that aren’t looking beyond the person in front of you, listen with ears that are truly hearing what is said and what is not said. And I guess I invoked those religious overtones because, done right, there is something sacred about this encounter: the air is somehow hushed and stilled, and an elusive but everyday virtue hovers near to light the way — but only if you truly and absolutely pay attention.