The act of writing is an integral part of my mental life; ideas emerge, are shapedOliver Sacks
At the beginning of medical school, I met with a senior physician to discuss career plans.
“Which specialties are you interested in?” He asked.
“To be honest, I can see myself doing anything from general surgery to psychiatry. I find there to be something fascinating in every specialty,” I replied.
“Well, you’re going to want to figure it out sooner than later, because surgery and psychiatry are very different from one another.”
It was only a couple of years later that I found myself stitching a patient’s self-inflicted wounds1, wielding tweezers and a needle driver while offering psychological counselling to someone who had experienced serious distress, and thinking to myself: “If only that doctor could see me now!”
I savoured the coincidence and irony of it all.
I then came across Lori Alvord‘s biography, and found out that the first Diné woman to ever become board certified in surgery in the United States uses new techniques to combine Western medicine with Navajo spirituality, and that she was an associate professor of surgery and psychiatry at Darmouth College for over ten years.
And all of this before meeting another medical student who loved both psychiatry and surgery, and telling me that it was because “both required masterful digging to get at the root of the problem, albeit with different instruments and techniques.”
I was pleased to see that I wasn’t the only one to see connections between seemingly irreconciliable medical fields.
But connecting the dots did continue to be a rarity throughout my medical training, and drawing discrete ones was the more common practice.
And in the age of Big Data, this might actually be a bigger problem than we think.
Already in 1963, a researcher by the name of Bernard K. Forscher likened data to bricks, compared hypotheses and scientific mental models to completed structures, and asserted that the number of bricks being produced was exponentially greater than the number of structures. As neuroscientist Matteo Farinella cleverly illustrates in his comic depicting Forscher’s opinion piece published in Science, we’re ending up with fields full of bricks with no room to erect any buildings.
And we’re missing scientific and clinical advancements hidden in those massive, disorganized heaps of information.
Don Swanson, a contemporary of Forscher’s, recognized the same problem, and asserted that it would only be aggravated by professionals’ modern tendency to hyperspecialize.
Swanson got his PhD in physics in 1952, and was eventually hired by the University of Chicago as the dean of the Graduate Library School. According to David Epstein in his book, Range:
“Swanson became concerned about increasing specialization, that it would lead to publications that catered only to a very small group of specialists and inhibit creativity. ‘The disparity between the total quantity of recorded knowledge… and the limited human capacity to assimilate it, is not only enormous now but grows unremittingly,’ he once said. How can frontiers be pushed, Swanson wondered, if one day it will take a lifetime just to reach them in each specialized domain? In 1960, the U.S. National Library of Medicine used about one hundred unique pairs of terms to index articles. By 2010, it was nearing one hundred thousand. Swanson felt that if this big bang of public knowledge continued apace, flying away from one another until each is invisible to every other. Given that he knew interdisciplinary problem solving was important, that was a conundrum.” (Epstein, Range, 2019)
Don “realized he could make discoveries by connecting information from scientific articles in subspecialty domains that never cited one another and that had no scientists who worked together. For example, by systematically cross-referencing databases of literature from different disciplines, he uncovered ‘eleven neglected connections’ between magnesium deficiency and migraine research, and proposed that they be tested. All of the information he found was in the public domain; it had just never been connected… In 2012, the American Headache Society and the American Academy of Neurology reviewed all the research on migraine prevention and concluded that magnesium should be considered as common treatment. The evidence for magnesium was as strong as the evidence for the most common remedies, like ibuprofen.” (Epstein, Range, 2019)
What Swanson deemed “undiscovered public knowledge” was a pile of untouched bricks that no one had tried to combine and layer.
And as the amount of published research continues to double every eight to nine years, so does our need for Swansons and Forschers.
Thus the next logical question: Where do we find them?
According to David Epstein, not among “specialists in a single knowledge domain,” since “big innovation most often happens when an outsider who may be far away from the surface of the problem reframes the problem in a way that unlocks the solution.” (Epstein, Range, 2019)
The need for specialists will never dwindle; even Epstein acknowledges that when we look for a surgeon, we prefer the one who has performed the desired procedure more times, for more years, with ever greater results.
But our age of Big Data is beckoning a new generalist; one who is more interested in connecting disparate disciplines and pools of data than in keeping them perpetually segregated.
It’s time to bring together seemingly dissimilar minds from apparently unrelated disciplines to help us, doctors and specialists, to look at this problem through different lenses and take on the challenge of creating a system to synthesize information as quickly as it’s produced.
(C) Laughsatives ’19
1Patient information was modified to preserve anonymity.