Leadership Intuition -Open-Mindedness (Out of Box Thinking)

Open-mindedness is the ability to accept novel ideas and thoughts into one’s repository of thoughts. It entails “thinking outside of the box,” considering unique, uncommon solutions to common and uncommon problems we face daily. An important aspect of open-mindedness, I believe, is to approach difficult scenarios with an open mind, or a tabula rasa—to look at them from a different angle or perspective one would not normally consider. By making decisions under this umbrella of open-mindedness, you must be willing to take a risk, regardless of whether this risk entails a low-reward yield in the outcome, embarrassment, or failure.

To illustrate the value of open-mindedness, let’s do a thought experiment. Think of something you do daily to which you don’t give a second thought. Perhaps this is something you are doing while reading the words on this page. For instance, one activity that many of us engage in throughout the day is walking. When we walk, whether it is inside our homes, at work, or while observing nature, we almost never pay attention to the fact that we are walking. It never occurs to us that we may be walking incorrectly. What I mean by this is that we may have a bad posture when walking or have an unsteady gait. Now I am sure that if we go to a doctor or some other professional, he or she can assess the way we walk and give us advice or consultation as to how we can improve our walking and prevent any health issues down the road. However, to even get to this level of thinking, you must approach the activities you do from the perspective that you have no idea or experience in doing that activity. With walking, you need to take a few steps back and consider: “Am I walking properly? Do I have a steady gait? Do I have any leg or lower back pain?” These questions may seem silly, but they all necessitate being open-minded to even ask oneself these questions. Getting the answers to these questions will allow us to uncover new information or a novel method of doing a particular activity. This unleashes new ways of thinking and will expand one’s repository of knowledge.

In my own career, clinical intuition has proven useful. From 1988–1993, I was an internist and pulmonologist at Al Midhnab General Hospital Saudi Arabia.

One warm night in July 1988, we had a 6-year-old child present to the ER with suspected meningitis. The chief pediatrician who was handling this case was explaining the situation to the father when I happened to walk by while rounding my patients. I overheard him say that they would get a lumbar puncture done and admit the child. To this day, I can’t tell you what compelled me to look. But I did. And I saw the child with the head tilted toward the right side: right dystonia. Perhaps it was something in the child’s expression, the way he looked, or his demeanor. Or maybe it was that the child wasn’t overtly expressing infectious symptoms like fever, headache, etc. All I knew was that my instincts were telling me that we weren’t dealing with meningitis. My mind was gravitating toward a medication side effect that I had seen countless times in my training. The anxious expression of the child was all the motivation I needed to step in and confirm the possibility my mind had hatched.

After getting permission from the pediatrician to evaluate the patient, I elicited a history from the father, focusing particularly on medications. I learned that the child had vomiting bouts a couple of days ago and was given metoclopramide. Afterward, he began presenting with right neck dystonia later that day. This was a common side effect of the medication, which I knew from my experience working in psychiatric wards. My diagnosis was clinched; I asked the nurse to prepare a valium injection. Once the injection was given, the child’s head began to rotate slowly back to normal like clockwork. Everyone was stunned. The father could not stop shaking my hand, and the pediatrician was in awe. The child, sullen faced earlier, was overjoyed. This may seem like a non-replicable, isolated incident. However, I assure you that many physicians have had similar experiences. Now the question is how do we teach this kind of skill?

A possible answer is that it comes from exposure to many permutations of clinical cases and symptoms with the goal of treating the patient holistically; a conclusion supported by Brokensha’s review from 2002. Furthermore, I will add that the art of physical diagnosis is an essential part of intuition and is central to developing strong observation skills. During my training, we took an exam where a standardized patient was evaluated in 15 minutes, and the student had to rely on his observation skill, palpatory, and physical exam skills to come to a diagnosis. In Pakistan, with the lack of resources in many clinics, it was imperative to master this skill. With the passage of the Affordable Care Act, I see a similar discussion taking place in the United States. A class focusing on developing clinical intuition into our medical curriculum can be a starting point. Maybe experienced physicians can keep a journal of interesting cases relying on their clinical intuition and then pass it on. Clinical intuition is still a valuable skill in modern health care and is both a celebration of our roots as healers and a lantern to the future of our profession.

By maintaining open-mindedness, readers can start making unique decisions in their life as a part of understanding the world around them in a way they may have never considered otherwise. For me, open-mindedness contributes to my happiness and gives me great pleasure and diversity in the activities I do and, in my thought, process.


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