The Artist, the Scientist and the Doctor in Each of Us

Oddly enough, amidst many flashier session topics advertised at the recent symposium, “Transform 2010: Thinking Differently About Health Care,” it was a modest three-word heading that most firmly caught my eye.

“Making Good Decisions,” the title read.

It sounded pretty ordinary at first. But come to think of it, what could be a more accurate description of the single most essential skill we need to guide ourselves safely across the bleak borderland dividing sickness from health?

What is every healing encounter in essence but a delicate dance of moral decision-making between the patient and all those who gather around to help?

To paraphrase the punch-line of the myth about the universe being made of turtles standing upon turtles, one could as well say that the practice of health care is morally complex and difficult decision-making, all the way down.

Having said that – and this is no knock on the most adventurous, open-minded and joyously humanistic health care confab in the world -- where was the moral philosopher in Transform 2010’s speaker lineup?

More specifically, where was the speaker to represent the new breed of scientists who in recent years have revolutionized the study of moral decision-making? These neuroscientists, social psychologists and evolutionary biologists have discovered nothing less than an entirely new perspective on who we really are as human beings – what really motivates us and why we act in the zigzagged, maddening, miraculous ways we do. They are rapidly spinning off new metaphors that may one day transform humanity as thoroughly as the heliocentric solar system or Einstein’s E=MC2.

These researchers – such as Antonio DamasioMichael GazzanigaJonathan Haidt and Elizabeth Phelps -- have created what was mostly dismissed as wishful thinking barely a decade ago: a new science of morality.

Their scientific findings are generating enormous excitement not only in the academic ivory tower, but also about possible practical applications in politicsethics and the law.

As yet, to my knowledge, no thinker or writer in health care has begun to systematically absorb, explore and apply the new science of morality to medical healing. For my money, though, the unique history and mindset of Mayo Clinic – perhaps through its pioneering Center for Innovation -- suits it perfectly to the task. I hope they take it up.

So what new view of humanity do the new moral scientists give us?

Here’s one way to summarize their findings: most of the time, human beings are unconscious. A far larger proportion of all of the decisions that we make in our lives – about 99%, the scientists say – are made by our unconscious minds and are based on automatic conditioning, than are made as the result of conscious thinking and principled will. We do have a precious chance to use analysis, reason and willpower to guide our actions, but it’s a tiny, fleeting one –1 percent or less of all decisions made.

Here’s another summary: at peak levels of skillfulness we navigate our lives more like artists than scientists. Especially when facing our biggest decisions we draw mainly upon the intuitive wisdom we have gained through our arduous human wanderings, and our hardwired moral conditioning, to guide our next steps.

Consider these stories of how unconscious decision-making shapes our lives, in much the same way that deep ocean currents create the surface weather in which we live:

  • People named “Dennis” are more likely to become dentists, and people named “ Lawrence ” are more likely to become lawyers.
  • Exposure to words related to the elderly make people walk more slowly; words related to rudeness make them act rudely; words related to politeness make them act politely.
  • Children who can resist the urge to eat a marshmallow that is placed in front of them, because later they will be given two marshmallows, later get into better colleges than children who are unable to resist the urge to eat a single marshmallow and thus delay gratification.
  • Ancient brain organs that regulate the emotions, especially the amygdala and the posterior cingulate cortex, make snap judgments about people within seconds of meeting them, and those judgments that rarely change thereafter.

The journalist David Brooks has offered a compelling description of how the new science of morality may influence public policy. In it we may read a suggestion of its potentially transformative impact on health care and health care policy as well:

“We try to do the things we do in the policy world. We try to increase high school graduation rates. We try to develop human capital. We try to close the achievement gap. But these policies often produce disappointing results. To me it’s because they are based on a shallow view of human nature and what levers you really need to pull to make some change. My hope is that the new cognitive revolution will give us a new humanism, a new view of who we are.”

In practical terms, who or what could bring the new science of morality fully into the health care world?

My ideal candidate is design thinking, a creativity discipline that helps many manufacturing and service companies stay fresh, innovative, collaborative and constantly open to changing conditions in the world.

Several health-focused innovation centers, such as Mayo Clinic’s Center for Innovation, are embedded inside host institutions. The designers who staff these centers have access to the inside workings of their host’s clinics and hospitals. Like anthropologists or journalists – sometimes they are actual anthropologists who have changed careers – the designers sit in on physician-patient consultations and visit surgical theaters, admitting offices and patient waiting rooms for weeks at a time, carefully noting the interactions they see. Through these sessions they build the archive of experience from which, later, using their artistic intuition, they create their new designs.

What is immensely hopeful is that the new science of morality offers a foundational, empirical, legitimizing rationale for health care designers to ply their trade.

Instead of being seen merely as artists whose skills are primarily aesthetic, or even simply decorative, the new science of morality connects design principles directly to the life and death matter of human healing.  The affinity of aesthetics and morality, once celebrated mainly by poets, artists and philosophers, is now a proven scientific fact.

Viewed through the lens of this new perspective on human nature, designers should and must be regarded as full and active collaborators in the health care process.

These two potential collaborators – designers and the new science of morality -- are already very close to each other in temperament and view.

Listen to Lorna Ross, the creative lead and manager of Mayo Clinic’s Center for Innovation, describe the sensibility and working methods of her trade:

“As designers we are trained to be fascinated by the human condition and to examine that heightened sensitivity to witnessing, particularly, the extremes. Everything we observe is a story and we are trained to see, to observe and to document what we see. Working in the area of health care we have a heightened sensitivity and level of empathy to the user. We quickly capture and synthesize what we see, and we store it as part of a catalog that we have around the human condition in general, and health care in particular.”

The delicate duet of patient and physician proceeds like a song with its own harmony, melody and rhythm. The two voices entwine and the resulting melody, harmony or disharmony translates into comfort or discomfort, health or illness, life or death.

This is the great lesson of the new moral science for anyone – doctor, patient, family member or health care designer – who is engaged in the mysterious, deeply human process of whispering our sick souls and bodies back to health.

The master of health is the artist inside each of us.

This post was written by Doug McGill.