This rule comes from Dr. Clifton Meador’s A Little Book of Doctors’ Rules, a book I received early in med school. What follows is an examination of Dr. Meador’s 302nd rule: Confusion is an essential phase of learning.
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Are you confused right now? I was when I read this. Let’s try and clear that up.
Confusion is Essential?
Confusion is embedded in the process of learning. It acts as resistance - something to overcome to learn. To overcome something you need effort, therefore learning requires effort. Since people earn worthwhile things through effort, and learning is a worthwhile pursuit, we can conclude that learning without confusion is learning unearned. It’s not possible. Put differently, there is nothing worthwhile gained without effort.
Why does all this matter? How does this apply to medicine? Right now, you may be saying “Tyler, this sounds like convoluted gobbledygook.” And… well… you may have a point…
HOWEVER, medicine as a whole is focused on people and bettering their lives. In the context of “effort,” we can understand the different ways someone can view their own life and, consequently, which view is the most beneficial. So, with the help of insights gleaned from the previous gobbledygook, we can understand the deeper meaning of this rule, how to communicate it, and how to apply it to our patients’ lives as well as our own. Let’s dive in.
How You View Life Matters
Through the lens of “effort,” we can see two ways of viewing life: active and passive. Let’s talk about passive first.
If you view life in a passive way, you might feel that life is something that happens to you. Therefore, you experience it as something outside of your control. Something that is passively experienced requires no effort, like sunbathing or watching Netflix. Since action is inherently uncomfortable because it requires effort, this perspective is founded on the desire for comfort.
I use “desire” instead of “virtue” here because comfort is ultimately fleeting. Taken to its logical conclusion, the pursuit of comfort results in stagnation and dissatisfaction because action is not possible. You can’t go anywhere or do anything…and that’s not good.
The second view is the active view. If you view life this way, you may say that life is something that you do, therefore you act it out. Instead of experiencing life, you act in the world to create it. This view is the more uncomfortable of the two, due to the effort it demands, however it is superior to the first because a person who adopts it doesn’t simply live - but lives well.
The passive viewpoint emphasizes existing; the active viewpoint emphasizes flourishing. This is the view that medicine should seek to support.
Focus on Flourishing
Flourishing, a worthwhile thing, is the process of becoming the best you can be – which is a process requiring effort. Flourishing encompasses many things and traits, (for example learning is a part of flourishing), but it is not an outcome for which you work or an endpoint you seek. It is a state of “being.” For example, existing is a passive state of being, whereas flourishing is an active state of being. In other words, by applying effort to your life you are in a state of flourishing.
What do people need to reach this state?
Well, you need effort applied over a long period of time. Effort + time = perseverance. However, perseverance alone, though important, will not equip you for the resistance you will face along the way. Going back to our rule as an example, perseverance alone won’t be enough to overcome the confusion requisite in the learning process.
Why is this?
Because resistance is not just temporal, but emotional and moral as well. Doubt and fear will creep into any arduous process; they are extremely powerful distractors and detractors. Since perseverance only affects time, perseverance alone will still leave you vulnerable to their attacks. Therefore, perseverance is only a component of the virtue at the core of this rule: Fortitude.
Adopt Fortitude to Flourish
Fortitude is the virtue of choosing to do what is right even in the face of extreme adversity, like overwhelming doubt and fear. In other words, you stand tall and stay resolute in situations where you’d much rather run away and crumble. It is the virtue from which things like courage, resolve, and perseverance are derived. It is not just temporal, but emotional and moral as well.
Since medicine seeks to help people flourish, and fortitude is needed to flourish, then fortitude is an important virtue that docs can adopt in their own lives and exhibit to their patients. Doctors lead by example. This then begs the question…
Is fortitude something you build or is it something you choose?
I think it’s both. You must first choose to adopt this virtue to live it out. When you make this choice, life will present opportunities for you to continually choose it. These opportunities allow you to practice, build, and strengthen fortitude in the face of obstacles and resistance. You must say, “My life can flourish. To flourish, I need fortitude. So I choose to act with fortitude and seek every opportunity to develop it.”
Confusion is Essential.
Let’s bring this essay full circle and back to rule 302 - confusion is an essential phase of learning. Confusion is indeed essential because it is an opportunity to choose and develop fortitude. Personally speaking, I chose to go to medical school where I’ve been perpetually confused learning the trade and all its accompanying “-ologies” (pathology, nephrology, pharmacology, etc). And that’s okay - that’s the point. Little by little, brick by brick, I become less and less confused.
Med school is my opportunity.
What’s yours?
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- Tyler
This post takes me back to a day early on in my college career…I was sitting in the office of my theater professor’s office, frustrated with the overwhelming volume of new material I had to learn in my combined course load. “This is too much! I can’t possibly remember all of this! What is the point if I can’t?” My professor simply looked at me and said “You won’t remember every piece of it, but right now you are learning how to learn. Absorbing new content, processing it, keeping what you need for the short-term or long-term (depending on the content) and then doing that over and over again.” Those words stick with me clear as day 25+ years later and l have used them with me son. This post is really a deep dive on that same idea. We overcome confusion by putting forth active effort to learn and flourish! Love it!
This makes me think about the people who have nothing to do and the people who always have a million things to do! I’ve always wondered if the perspective of “being interested” is learned or something you are born with. I think I’m going to love your blog!