“The brain is like Velcro for negative experiences and Teflon for positive ones.”
This is a quotation attributed to Dr. Rick Hanson, and I first heard it today in a STREAM Faculty Development presentation I attended.
There’s a lot to chew on with that statement, I think, and I wanted to share some of my thoughts with you. I think there are valuable lessons about medical education that can be extracted from reflection on this statement.
Neuroscientists have demonstrated that the human brain has a natural negativity bias, and we are all prone to internalize and hang on to negative experiences more deeply than positive ones. Hence, the analogy that negative experiences are like “Velcro” while positive experiences are like “Teflon.”
I don’t have data for this, but I would hypothesize that this phenomenon is likely even stronger for physicians than for other professionals. I don’t know a single colleague who can’t enumerate any number of mistakes they have made or patient complaints they have heard. Those things stick. Moreover, when we receive praise, I think we are likely to take any sort of joy in that experience for the briefest of moments, before we let go of it and move on.
Using myself as an example, I know for certain that when a patient or family praises me, I think immediately of Rudyard Kipling’s poem, If, “If you can meet with Triumph and Disaster, and treat those two impostors the same….”
Praise and criticism. Two impostors. Or two sides of the same coin, if you will. There is a certain wisdom to treating these phenomena as illusions and not attaching oneself too strongly to either the feelings of pride or shame that, respectively, praise or criticism may engender.
But I would argue that addressing negative experiences, in particular, head on can be invaluable in our medical training, both for the learner and the teacher. That is, spending time with the negative and treating it as a reality and not an ‘impostor’ is important. And I’m not thinking about punitive measures here.
I’d like to share a brief vignette of how an esteemed teacher in my fellowship used my mistake to teach me, in a very positive way, lessons for medical care that I will never forget. It’s a Velcro moment for me as a physician, for sure, but in a special way: because of a special teacher, the stickiness of the negative experience has been a great help to me as a physician.
I did my sports medicine training at Boston Children’s Hospital, under the legendary orthopaedic surgeon Lyle Micheli, MD. Dr. Micheli was renowned for his busy practice and the high standards to which he held the people he worked with. He demanded total commitment to patient care.
Early in my fellowship, I was taking care of a dancer for the Boston Ballet – a professional ballerina who had sustained a stress fracture in the foot. Dr. Micheli was the Medical Director for the Ballet. The injury itself put the dancer’s career at risk (dancing en pointe was out of the question until the stress fracture healed) and I had the patient in a non-weight bearing cast for eight weeks, planning on bringing her in to take the cast down and demonstrate healing with an x-ray. When we diagnosed her, she had access to a bone stimulator at the Ballet. Checking with an attending, but not with Dr. Micheli, I said that no, we would not use this, as one does not use this device over a cast [this was wrong, as I learned over the course of the fellowship].
When the young woman presented on the day we could start getting her walking out of a cast and transitioning back to dance, I took her out of the cast and found, on the x-ray, that the stress fracture had not yet healed. She was despondent. I was mortified. I also learned that day from another attending that, in fact, I should have been instructing the patient to use the bone stimulator and likely, if I had, the fracture would have healed.
I poked my head into Dr. Micheli’s clinic to let him know about one of the dancers in ‘his’ Ballet corps. I feared the worst. I apologized and steadied myself for what I thought was the coming, and appropriate, dressing down.
Instead, he asked me to bring in the dancer. He sat with her and listened to her. He gently examined her foot and explained that we would have to re-cast her and get her back on crutches, but this time with the bone stimulator in use. He casted the patient himself [at his level as an attending, this would equal the most basic scut work that would be assigned normally to a trainee like me, but which he did instead}. While his own clinic was backing up, he took all the time necessary to comfort and allay the fears of this patient.
Dr. Micheli showed me several things that day, and he re-demonstrated these over and over that year I trained under him. First, embrace your failures. Don’t run away from them. If you make a medical mistake, embrace it and be transparent. Spend more time with your patient, not less. This will not allay all your patient’s negative emotions, but will go a long way towards their maintaining faith in you. Second, learn from your failures. Analyze the negative experience and extract whatever lessons you can from that experience. It will serve you in good stead next time. Third, as a teacher, be gentle with your learner when a mistake is made. Don’t get me wrong: Dr. Micheli could be ‘old school’! Like an Old Testament prophet, he would let you know in no uncertain terms if he perceived you did something out of laziness or carelessness. But if he knew you cared and knew you had made an honest mistake, he would treat you as he did me.
He exemplified Dr. Francis Peabody’s famous dictum: “The secret of caring for the patient is to care for the patient.”
The “Velcro” quality of negative experiences is part of our brain’s wiring. If we understand this and use that quality to our advantage, we can turn the persistence of a negative memory into something positive. The memory of this mistake has remained with me my entire medical career. But it is how my teacher, Dr. Micheli, turned this mistake into a moment of teaching that has made the experience a blessing for me professionally.
James MacDonald MD, MPH
James MacDonald, MD, MPH is a physician for Nationwide Children’s Sports Medicine and a Clinical Professor in the Department of Pediatrics and Family Medicine at The Ohio State University College of Medicine. He is fellowship trained and board certified in sports medicine. He is a member of the American College of Sports Medicine, the American Medical Society for Sports Medicine and the American Academy of Family Physicians. Dr. MacDonald attended medical school at Harvard Medical School before completing a Family Practice Residency at Maine-Dartmouth in Augusta, ME and a Sports Medicine Fellowship at Boston Children’s Hospital in Boston, MA. He is a member of the USA Swimming Medical Task Force and an Associate Editor of the Clinical Journal of Sports Medicine.