I Don't Know

Over the thirty-six years of my practice I have observed some processes of growth in myself and in others. I have read of the accounts of such growth in many different books and articles and now I have observed and, hopefully, participated in the growth that comes over time. My observations pertain to the healing arts; however, I don’t think the process is unique to just the healing arts or health care. As a disclaimer, I do not pretend to be the first or even near the first to observe this phenomenon of change and growth; in fact I am probably way down a long list of everyone that has preceded me. I am not assuming either that I have reached some level of great wisdom. Be that as it may, I feel compelled to write this essay on my observations in the hopes that it may help someone else move forward in life a little faster.

The training of new physicians in the western world is a long and tortuous process. Physicians are taught anatomy, physiology, pathology, histology, biochemistry, diagnosis, treatments and remedies. Most are put through an intern or externship of months to several years. Allopathic physicians are, for the most part housed in institutional hospital settings that cater to the most advanced and acute cases of disease and injury. Dental, Chiropractic and Naturopathic students see patients in a crisis for the most part and for a short time. None of the new professionals are allowed to observe the overall progression of dis-ease or to come to some understanding of the total process of dis-ease. The training that is received is world class, excellent, well intended. The training, however, does not really address people as human beings and it does not, in most cases, allow the physician to develop his or her humanity into being a “healer”. (Healer being defined as someone who is able to facilitate and assist in the self-healing of another person) An example of what I would offer as a possibly more ideal model, in the intern phase, and even perhaps the basic science phase of training, is the older Eastern apprenticeship model of training whereby the intern, apprentice, would work with, under, a “master” until such time as the master felt the intern was ready to “care” for mankind. This process allowed for the full development of the physician over a period of twenty to thirty years. He was able to progress to a mature level of understanding of a human being and not just of their ailments. (I do not hold out much hope that this will occur, nor do I deny that there are inherent weaknesses and drawbacks to the apprentice model.)

What about the apprenticeship form of training makes it a more effective form of learning? It is my observation that there are three stages of maturity in an adult. The three are:
1. To Know About
2. To Know
3. To Know I Don’t Know

The first phase of maturity, “to know about”, is the first ten to fifteen years of practice or learning. The new physician knows about many things. He is well trained. She is competent and, in many cases, more aware of the latest technology. They may be more open to a new idea and not react in a “knee-jerk” manner to situations. The down side is that this person has no background or experience to understand what is happening. They have not seen or experienced the good and the bad outcomes of their ministrations. They have not dealt with enough people to understand or at least recognize the various idiosyncrasies of being human. Their knowledge, for the most part, is from “the book”. Their actions can be hesitant, indecisive, and without the quick reactions that come from having been in a situation before. They have nothing else to fall back on but the textbook. They, therefore, tend to be more dogmatic and defensive of their procedures and their decisions. They tend to hide behind their books and studies.

The second phase of maturity, “to know”, is the middle phase of growth, from ten to twenty or thirty years in practice. This physician has experience. She has seen many cases and people. He is able to see through and around many of the problems that people will bring. He is current with most new technologies. She is active and a strong advocate for various issues. This practitioner takes stands and leads charges for change. He has enough experience that his actions are almost automatic. Much good comes from this stage of growth. The down side, however, can be an inability to see errors in himself. Pride, arrogance, determination, all the things that make her a great leader also handicap him as a physician. His heart and head are not open, he has made up his mind and that is the way it is to be. A sense of immortality and righteousness seem to surround this individual. Short term purpose and goals dominate. Acquisitions, accomplishments, drive to succeed are obvious characteristics. However, boredom, indifference and loss of purpose, mid-life crisis, a “is this all there is?” attitude, are common afflictions in the later phase of this time of life are commonly noted in large part due to materialistic goals and objectives (acknowledged or not).

The third phase is that of “To know I don’t know”. This is the more mature provider of the art of “healing”, a “master” of his craft. Having seen much, experienced much and been humbled often, the mature practitioner is able to listen, hear, and notice what is happening with her patient. He can feel, empathize with, what the patient is experiencing. He has been around long enough to know that he doesn’t know and therefore he must be continually looking for answers, opportunities. She knows that for each answer she gets it will raise at least three more questions and that there are things that can’t be answered. He is willing to ask. These people are more humble because they know that nothing they have done could have been done alone. For every accomplishment that is hailed as original, he knows that it is based on the work of countless others that have led him to his conclusions and actions and that in his past there were those that paid for his mistakes that taught him what he knows now. Obviously, some of the dangers that are a part of this last phase are boredom, indifference, withdrawal, fatigue, surrender, extreme frustration and a sense, in this society, of uselessness, or, at the other extreme, arrogance, selfishness and ego.

The third stage is the stage of teaching and sharing. Some call it “sageing”. Having seen enough cases, dealt with enough people and situations this doctor can see beyond the immediate situation and help guide the patient or the young doctor on a course of recovery and improved health. The accumulation of financial security behind or at least taken care of, allows a sense of detachment and yet commitment to the larger picture of human existence. It allows the physician to teach with a “ruthless compassion” that knows the pain that her words may cause the student, but knows also that it is less than the pain of learning by failing with a patient. Or learn by dying prematurely. It is a phase of humility and yet a possible appearance of arrogance by those that think they know. It is a time of bigger visions.

It seems, then, that life begins with a blank slate knowing and having nothing and ends with acknowledgment that we know nothing, but that the knowing we know nothing is something…and then we die. Or we begin again.

I don’t know.