Jeremy

Part of what I’m hearing from Jack and maybe a little from Mark is an important question: Are anecdotes scientific? I mean, people may be utilizing anecdotes to make decisions because their emotional cortex and social cortex are involved in decision-making probably more than their intellectual, rational mind.  I think it is fairly well demonstrated in the economic realm that people are not rational beings making rational decisions. We resist abandoning the assumption of rationality because we believe so strongly in the objectivism model. And we call everybody who works in the anecdotal world quacks and sub-scientists. But are we wrong there? Because as individuals, people make decisions maybe based more on anecdotes. If their aunt said this is true, that would change their mind more than the doctor with 17 pages of lab tests. And that bothers us as physicians, which I understand. And yet that’s part of what I think is interesting here. Have we lost touch with how people really make decisions? Is the emotional piece of this missing in the objectivism? That’s my assumption.

Bill G

But Jeremy, hasn’t the paradigm at least started to shift somewhat? What about the new program requirements in the behavioral health component concerning instruction in motivational interviewing? The curriculum now requires training and education regarding how to interact with patients in terms of delving into this more constructivist context. How do they view their illness, and how do they view their path to wellness? You are to help them positively define their narrative. I mean, that’s what you teach now, isn’t it? Don’t all your residents have motivational skills?

Jeremy

I absolutely would agree that this is happening in family medicine. I can’t speak for behavioral health, but they’ve been doing this much longer than we have. Hopefully, we are pivoting in the direction of shared decision-making models. However, the objectivist construct inside of which we’re working does not favor that. So, we give you 15 minutes to have a 45-minute conversation with your patient. This contradiction is not lost on the young generation. I really want to do this, but actually I get paid to do this. And so you’re teaching me something that sounds nice. I’ll be taught all about lifestyle medicine. This is absolutely fascinating. I’ve incorporated this into my own life. I’m walking more. I’m exercising more, but I don’t have time to have these conversations with my patients, so I just prescribe them a little statin, and we move on to the next topic.

Bill B

I want to bring in the wisdom and expertise of my colleague, Gay Terman. As Gay mentioned, she’s doing work with neurofeedback. She is doing work that delights the objectivists. As an objectivist, I can sit here and say: Here’s how my brain is functioning, and here’s this beautiful picture and all that. But Gay actually listens to people first, before and after the technologies. Unlike many of the people using the tools that Gay uses, she incorporates that in a much broader narrative, which I think is so critical. She is a constructivist! In fact, Jack, it’s an example of what you’re talking about. How do you combine the scientific—and certainly the neural work that Gay is “very scientific”—with the narrative