Curiosity for Subtle Detail

As a young man I accepted the wisdom of doctors and their prescriptions without question, never bothering to learn the names of the drugs they ordered. After reading Jerome Groopman’s book How Doctors Think, I am not so sure I want to go back to a doctor! The ten to fifteen percent error rate in diagnosis and similar percentage in the misreading of x-rays and MRIs does not give one confidence in the medical profession. The nearly socialized nature of the medical market today does not help and no doubt contributes to the penchant of doctors to interrupt patients after only eighteen seconds and decide on a diagnosis within twenty. Add to this the failures to probe or to consider alternative, possibly subtle, explanations of symptoms, the stereotyping of patients, the worshipping of averages, the “this is how we’ve always done it” mentality, and the pressures to conform and not order more tests—and you have a prescription for bad medicine.

But Groopman’s book is not just about how doctors think—or rather, do not think; the errors apply equally to teachers and other professionals, as well as to anyone who has a problem to be solved or person to be judged. The arrogance, for example, that doctors are sometimes accused of is not the prerogative of medicine. Groopman’s parents were told by his fifth-grade teacher that he was “not college material” and an Ivy-League-trained first-grade teacher of the son of one of my colleagues predicted that the boy would become a high school dropout. (The colleague’s son is now applying to graduate school.) What are these errors and how can they be avoided?

Groopman’s book is a work of epistemology that describes how everyone tends to think at one time or another. Better thinkers, though, as Groopman points out, do not often make the mistakes he discusses and, more importantly, make concerted efforts to learn from the mistakes they do make. (One doctor that Groopman mentions keeps a log of each mistake he makes and analyzes why the error occurred.) Bad thinkers are not usually aware that they have committed any such errors, or if they are, choose to do nothing about them. I would characterize the essential mistake described in Groopman’s book as a mental passivity that lacks curiosity for subtle detail.

Curiosity is an eagerness to know, and knowing subtle detail requires the ability and willingness to make fine distinctions or to delve deeper and deeper beneath surface appearances. Not many people seem willing, or perhaps know how, to go this distance. The curiosity does not require a college education. I recall a garage door repairman who told me about a difficult-to-diagnose malfunction; he finally figured out that the sun’s reflection off the car that was frequently parked in front of the garage interfered with the electric eye controlling the door. With an eager glint in his eye, the repairman said, “That was an interesting problem!” This man certainly did not have a college education and possibly not a high school degree, but he did have what I would call a curiosity for subtle detail.

Judging other people—as doctors must judge their patients; as also parents must judge their children, teachers their students, managers their employees; as everyone must judge others with whom they come into contact, whether friend or foe—is not an easy task. It requires effort to gather data—facts—about the other person. Failure to gather one fact can change a negative evaluation to a positive, or vice versa. Omniscience is not possible, so rules-of-thumb based on past experience help make decisions. The better the past experience the better the rules-of-thumb. This means that accumulated knowledge is a factor in making sound judgments, but interest and desire to go beyond what too often become comfortable rules-of-thumb are what cause one person to see facts that another does not. Continued observation, not contentment, and a determined search for clues that might solve a problem or explain a behavior are what separate good thinkers from bad. And, further, as new evidence arises, the additional information is acknowledged by the good thinker and revision of a previous judgment, if necessary, is gladly made.

Curiosity for subtle detail is a commitment to observation, the commitment of a scientist in all areas of one’s life. It is a commitment to spot the relevant in the mass of data that daily confronts us and sometimes a commitment to stand in opposition to the conventional wisdom that might ignore or silence us.