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Boundaries of knowledge


This post, from Ben Symon on the limits of knowledge, is the first of our 2022 DFTB conference. Some tickets are still left for DFTB23 in Adelaide, so sign up while you can.

Ben Symon is a pediatric emergency medicine physician. He’s fascinated by the interactions and boundaries between how we interact together as clinicians and with our patients.

Kindness is central to our specialty – but it should be central to all of our specialties. So why isn’t it?

In this talk, Ben dissects the healthcare system and finds that hospitals have immune systems to protect them from unnecessary referrals, and one of the primary neutrophils they have is shame; creating a sense of shame to be called and a sense of shame for not knowing what to do. Kindness is not, and should not, be a precious resource doled out sparingly to those we think deserve it.

Echoing Vic Brazil, in her talk from 2018, he reminds us that tribalism is still rife in our healthcare system and that we are all complicit in the othering that takes place in tea rooms and in elevators every day. We must tell stories that lift each other up, not drag the other person down.

According to Malcolm Gladwell, the podcaster and famous author, we don’t just store our knowledge in our minds or in paper or on calendars or in photos; we store our knowledge and our memories in the minds of the people that we love.

In the 1980s, Dan Wenger looked at couples who’d been in long-term relationships. He found that when people have been in long-term loving relationships, they don’t both try and remember everything about their lives. Instead, they distribute that knowledge between them so that they can each hold more. Wenger was able to prove that by distributing knowledge between each other, they were able to remember more accurately than couples people who were interviewed alone. By distributing their memory between them, they became more than the sum of their parts. It happens in healthcare too.

We store knowledge of the heart in the Cardiology team. We store memories of what the pancreas does in the endocrine team. We store the knowledge of how to cut open patients and fix what’s physically wrong with them with surgeons. We store the ability to look after a patient who’s on the edge of death for hours at a time in ICU nurses, and we saw the knowledge of where the hell anything is in the hospital in our wardies. We have collectively agreed that we cannot hold everything, everywhere, all at once, so we split into teams and streams.

Over time we have to start forgetting other people’s buckets of knowledge. But we still judge others unfairly, by their knowledge of our bucket, not their own.

It’s time to stop.




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