Clinical Curiosity: an antidote to medical arrogance.

David Jeffrey is a Senior Lecturer, Lead for Ethics & Law, in the new Three Counties Medical School, Worcester

Martha, a 13-year-old girl, died in 2021 following a series of failures in her medical care. Her mother described how arrogant  doctors failed to listen to her concerns as her daughter’s condition deteriorated, declining to refer her to intensive care, with tragic consequences.^1,2 Martha’s sad story should prompt every clinician to reflect on the factors which inhibit clinical curiosity, including medical arrogance, and to examine ways to enhance curiosity in medical education and clinical care.

Clinical curiosity: a desire to know and to learn.

Clinical curiosity is an essential part of a doctor’s empathy and clinical decision-making. It promotes reflective practice, critical thinking and stimulates lifelong learning. Clinical curiosity is concerned both with gaining knowledge and understanding  the experience of others.³ Patients perceive doctors who ask questions of them as being kind.⁴ In the drive for efficiency in the NHS there is a risk that doctors may feel that they have less time to listen to the concerns of the patient and their family. However, failure to listen adequately to these concerns is a common cause of medical error.⁵

Medical teaching can inhibit students’ expressions of curiosity from fears of criticism or humiliation. A virtual learning environment can create the illusion that it is more real than the living patient and  so may suppress clinical curiosity.⁴

Medical arrogance: a threat to patient safety

Medical arrogance is characterised by a combination of a lack of curiosity and overwhelming self-confidence. This combination is hard for patients or colleagues to challenge. Doctors lacking in clinical curiosity may stick with initial impressions, fail to challenge senior colleagues and fail to pursue alternative diagnoses.⁵  Perhaps the competition to enter medical school engenders a feeling in  certain students that they are ‘special.’ Students may even be encouraged to present an attitude of certainty. Expressions of gratitude from patients and deferring colleagues might lead some doctors to believe in their infallibility and superiority.

Organisations as well as individuals may display arrogance. The Francis Report  and the Ockenden Review both revealed gross failures in care and a failure of management to listen to families’ concerns.^6,7

Challenging medical arrogance

Fostering situations where clinical curiosity is encouraged and doctors are given an opportunity to have their assumptions challenged by a supportive mentor would help to address medical arrogance. Doctors should recognise and be able to confront over-confidence in colleagues. Exposure to positive role models, demonstrating humility and empathy, can also help to modify arrogant behaviour.⁸

Enhancing clinical curiosity

Allowing patients to express their concerns is not as time consuming as one might assume and might also avoid unnecessary investigations and procedures. Curiosity flourishes in an environment which promotes the principles of self- directed adult learning. Primary care can provide students with opportunities to meet real patients and to create a safe space with time for reflection and discussion. Medical students and doctors need to be curious about their own abilities and open to feedback, to develop their clinical practice. Students and doctors need to prioritise listening carefully to the patient’s story, gaining in narrative competence.

Conclusion

Clinical curiosity enables doctors to enter empathic relationships with patients. Curiosity leads to a more accurate diagnosis and to a patient who appreciates the involvement of an interested doctor. Arrogance and overconfidence, characterised by a lack of curiosity, should be addressed at recruitment, training and in practice. Arrogant doctors or students should be made aware of their risk to patient safety. Medical educators have a role in fostering curiosity in their students, freeing them to embrace emotions, acknowledge uncertainty with humility and enjoy empathic relations with patients and their families.

References

1. Mills M. We Had such trust,we feel such fools: how shocking hospital mistakes led to our daughter’s death. Guardian. 3rd September 2022. https://www.theguardian.com/lifeandstyle/2022/sep/03/13-year-old-daughter-dead-in-five-weeks-hospital-mistakes (accessed 29^th October 2023)
2. Khan N. Martha’s Rule: what does it mean for general practice? British Journal of General Practice. 2023;73:504-5.
3. Dyche L, RM. E. Curiosity and medical education. Medical Education. 2011;45:663-8.
4. Fitzgerald FT. Curiosity. Ann Intern Med. 1999;130:70-2.
5. Redelmeier DA. The cognitive psychology of missed diagnosis. Ann Intern Med. 2005;142:115-20.
6. Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive Summary. London: HMSO; 2013.
7. Ockenden Report Findings, Conclusions and Essential Actions from an Independent Review of Maternity  Services Shrewsbury and Telford Hospitals NHS Trust. London; 2022.
8. Lempp H, Seale C. The hidden curriculum in undergraduate medical education: qualitative study of medical students’ perceptions of teaching. BMJ. 2004;329(7469):770-3.

Featured photo by Towfiqu barbhuiya on Unsplash.