This article was published in Scientific American’s former blog network and reflects the views of the author, not necessarily those of Scientific American
I am in a room with 1,500 other people. Some are physicians; some are interested in business; there are lawyers, researchers, journalists, songwriters, dancers; some are patients with stories to tell. What we have in common is that we are all interested in health.
Welcome to TEDMED 2012 – the world’s only TED-licensed event “focused solely on innovation and breakthrough thinking across all of health and medicine.”
I arrived at the annual conference in Washington, DC yesterday evening. The first speaker, lawyer Bryan Stevenson, talked about the power of identity. Words have more influence if they are wrapped behind an identity, he said.
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What does that mean for medicine?
Last week in my ethics class, our topic of discussion was end of life issues. We watched a powerful video featuring a patient who suffered a severe spinal cord injury. Paralyzed from the neck down and ventilator dependent, he ultimately came to decide that life was no longer worth living.
His physicians adored him; he knew broaching the conversation would be difficult. When he finally did, he chose his words carefully. He did not say he wanted to die.
Rather, he said he wanted to withdraw care. When you say you want to withdraw care, then the docs listen, he informed us through the screen.
But why?
A person who wants to die comes across as a fundamentally different person from someone who wants to withdraw care. It’s a matter of identity.
When a patient says he wants to die, the knee-jerk reaction of providers is extreme concern, coupled with an impulse to treat. Are you depressed? Could this depression be helped with therapy, conversation, medication? A person who wants to die is a person in urgent need of mental health intervention.
A person who wants to withdraw care, however, has an ethical and legal right to do so. Physicians are certainly still concerned about this person, yes – but the nature of the conversation is different. We can have the conversation.
Wanting to die is a treatable condition; withdrawing care is an option.
The patient in the video was acutely aware of that distinction. That’s why he presented himself the way he did. By shaping his identity, he shaped his physicians’ impressions of him. He guided the conversation they were able to have.
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When I received my registration email from TEDMED a few weeks ago, they asked me to create a badge. It seemed like a straightforward enough task: what is your name, and what is your role?
Yet after I typed in my name, I found myself pausing. What would my identity be?
There are approximately 1,500 people at this conference, all of them interested in some facet of health. I’ve introduced myself to several. My introduction is not yet standardized. I tend to present myself as a medical student when I am speaking with other students or physicians, and I introduce myself as a Scientific American blogger when around members of the press. Instinctively, I want to emphasize the overlap with the person I am speaking with.
And, the meaning of my words indeed changes depending on which I choose. A personal reflection on medicine, when I am a medical student, can be confused for something my school teaches and supports. A question, when I am a blogger, is confused as an interview query. No, I am not going to quote you; I was just wondering.
As for the badge I am wearing, I went for the wordy cop-out: “medical student
blogger.”
Over the next few days, I will be hearing the perspectives of sixty speakers. Each has a reflection on medicine through the lens of a particular identity. A doctor. A CEO. A songwriter.
I am sure each of them had multiple potential identities to choose from when they constructed their talks. They picked one – and shaped the conversation we are
able to have.
They want to be influential. I imagine most of us at this conference want to be influential.
Words have more influence when tied to an identity.
The question is: how to choose?
(TEMED2012 runs until Friday, April 13th. More to come soon.)