Thinking Like Leonardo da Vinci and Its Implications for the Modern Doctor

Physicians have a reputation as being in a profession that is associated with innovation, creativity, and, now, entrepreneurship. However, most physicians pale in these regards when compared with one of the greatest thinkers and innovators of all time: Leonardo da Vinci.

For this chapter, I interviewed Michael Gelb (www.michaelgelb.com), the author of How to Think Like Leonardo da Vinci (Dell, 2000). This chapter explores the seven da Vincian principles that are drawn from an intense study of his notebooks, which are considered some of the most prized manuscripts ever written and may even rival the Dead Sea Scrolls in importance! After reading this chapter and this interview, you will learn how to incorporate these principles into your practice and personal life.

Da Vinci, according to Gelb, has a message that applies to contemporary physicians who are trying to improve their services to their patients. Da Vinci encouraged his students to continually develop professionally. He served as a role model for life-long learning. Not only does da Vinci inspire us to learn, but he provides us with seven principles that healthcare professionals can use to enhance their skills. Gelb states that most biographies on da Vinci focus on his art, accomplishments, and inventions. Gelb takes da Vinci to the next level, and teaches the reader how to develop a strategy for life-long growth and continual improvement.

CURIOSITA

The first principle is curiosita, or having an insatiably curious approach to life and an unrelenting quest for improvement. Probably no professional asks the question, “What if” more than a physician does. What if we could treat stomach ulcers with antibiotics instead of antacids or surgery? What if we could crush a kidney stone using shock waves instead of scalpels? These were questions that were asked and answered; and, as a result, changed the course of medicine.

Gelb quotes Carol Dweck, a professor of psychology at Stanford, who pioneered the idea that people can be classified into one of two mindsets: those with a fixed mindset or those with a growth mindset. She notes that less successful people have a fixed mindset. They may be very talented people, but they don’t optimize their gifts. They are afraid of making mistakes and afraid of failure. These are physicians that practice defensive medicine and order expensive tests even when they are certain of the diagnosis.

On the other hand, most successful people have a growth mindset, which is the result of curiosity. Curiosity means always looking for feedback, even if it is negative. These physicians are always looking for ways to improve their service. They are the ones that survey their patients and ask their opinion of their care and how the service can be improved. Those with a growth mindset are always seeking knowledge. Yes, those with a growth mindset make mistakes, but they treat mistakes as learning experiences.

DIMOSTRAZIONE

The second principle is dimostrazione, a commitment to test knowledge through experience, persistence, and a willingness to learn from mistakes. Those students of da Vinci that practice this principle have the ability to look at a problem from multiple perspectives. They aren’t part of the status quo; they are independent thinkers.

Doctors often have a difficult or challenging case, and they may initially feel uncertain about their opinion. After all, when you are involved in the care of another human being, there’s a lot at stake. When patients feel that there is an element of equivocation on the part of the treating physician, they may obtain another opinion, which may differ from the original opinion. Da Vinci also encountered problems in his work, and he had a network of other artisans or colleagues and mentors with whom he could cross-reference his thinking. Do you have such a network of colleagues and teachers with whom you can consult in these situations? Da Vinci would suggest that you be open to alternative ideas sooner rather than later. He would remind you that your primary purpose is to be of service to your patient by serving your patient. This is far more important than being right. This is one of the most important lessons of da Vinci. Helping others and service to others is what the practice of medicine is all about. We should strive to be the best caregiver to each patient who is dependent on us for judgment and clarity of thinking.

SENAZIONE

Senazione is the continual refinement of the senses, especially sight and hearing, as the means to enliven experience. The best physicians pay attention to their patients and what the patients say and do. These physicians are looking at and listening to their patients during their interaction. These outstanding physicians gave their full, undivided attention the patient. They practice mindfulness, which, among other things, is an attentive awareness of the moment.

Doctors who are in the present moment are not distracted. Even if the doctor spends only five minutes with the patient, he or she spends 100% of his or her time meaningfully engaged with the patient and focused on the patient. If da Vinci were a doctor, he would really look at the patient and actively listen to what the patient says. Da Vinci would not be looking at the computer or the iPad, but at the patient. He would not be standing if the patient was sitting down. He would be asking open-ended questions and then listening attentively to the patient’s responses. It is probably true that patients will use your focused attention as part of their decision-making to select and maintain a relationship with a physician.

SFUMATO

Sfumato is a willingness to embrace ambiguity, paradox, and uncertainty. As a physician, we can’t always be certain of the right thing to do. There seems to be pressure on physicians to always have the right answer. For the most part, there are neither rewards nor much motivation for sleeping on a problem, but there are occasions when it is beneficial and in the patient’s best interest to do just that. It is not possible to always know the answer immediately with each interaction with a patient.

According Gelb, da Vinci would advise you to think about a problem as hard as you can, and then think of the problem from multiple perspectives. Then da Vinci would recommend that you walk away and take a deep breath, have a little relaxation, then sleep on it. Gelb points out that neuroscience now validates what da Vinci suggested. When you sleep on a problem, you consolidate new patterns of connection in your brain. By sleeping on the problem, you integrate new learning and new thinking. Da Vinci would often take a nap and then note improvement in his problem-solving ability as well as his creativity. Research shows that pilots who take 20-minute naps increase their performance, reaction time, and fine motor movements significantly. It is a good idea to get plenty of rest; and if you are confronted with a challenge, sleep on the problem. Certainly doctors, especially surgeons, may be required to make split-second decisions. However, if you have time, take time to sleep on it.

ARTE/SCIENZA

Arte/Scienza is the development of the balance between science and art, logic and imagination (i.e., whole-brain thinking). The best physicians combine logic and imagination, and rationality and intuition. The best diagnosticians often have a gut feeling what the diagnosis is, although the doctor may still need to order tests to validate his or her intuition. As you continue to study the science of medicine, you will find that you will be listening more with your gut. The more you learn, the more patients you see, and the more curious you are, the more you will nurture your ability to process information quickly.

Malcolm Gladwell in his book Blink (Back Bay Books, 2007) describes a story in which a museum curator was asked whether an Egyptian statue was authentic or a fake. Immediately, the expert said it was a fake because he could tell that a machine crafted the fingernails on the statue. The curator knew from his experience of seeing thousands of statutes that the art piece was not authentic. Physicians who see patients day after day get better at making gut decisions. Da Vinci would advise you to analyze all the data first and then trust your gut.

CORPORALITA

Corporalita is the cultivation of grace, ambidexterity, fitness, and poise. This step requires the balance of both the body and the mind. Da Vinci was way ahead of his time in understanding the mind-body connection. He might advise the contemporary physician, “Doctor, heal thyself,” meaning that physicians should learn to preserve their own health. Da Vinci was an advocate of the importance of a healthy lifestyle, recommending nearly 500 years ago to “avoid grievous moods and keep your mind cheerful.”

The Vitruvian Man (Figure 1) is da Vinci’s image of divine proportions, and it remains a symbol for holistic health. Da Vinci believed that the human body was a microcosm of the harmony of the whole universe. He suggested that you treat the part of the patient or organ system that you studied during the many years spent in training; however, you should pay attention to the whole person. I can remember a staff member referring to the “prolapse patient in Room 1,” and this is emblematic of the healthcare profession often using anatomic parts to discuss patients rather than referring to patients by at least their first names since using last names in the hallways can be a violation of the HIPAA guidelines.

FIGURE 1. The Vitruvian Man.

CONNESSIONE

Connessione is a recognition of and appreciation for the interconnectedness of all things and phenomena — systems thinking. Da Vinci understood that everything connects to everything else. Da Vinci was one of the first systems thinkers. He suggested that we look at the person in the context of how everything is connected to everything else in the universe and related to everyone on the planet.

If da Vinci was a physician, he would ask, “What are the factors that are impacting this patient’s illness?” He would make connections that others wouldn’t see; remember that da Vinci tried to invent the parachute long before anyone could fly! He would consider that if he prescribed a drug, it might solve the patient’s problem, but what other problems would it create? I know there have been times when I prescribed a medication, and the adverse effects of the drug were more problematic than the problem I was trying to solve by prescribing the medication. I think it is imperative that as physicians we think through these issues and discuss with our patients the risks and benefits of the treatments that we often offer them.

Bottom Line: No one knows for sure what the future will bring. We do know that there are going to be events that take place that may discourage us. However, we can still feel cheerful and bring joy to our patients. Da Vinci and his seven principles offer a way to enhance our relationship with our patients and to improve our level of care and compassion as we try to guide patients on a path to good health and well-being.

Excerpted from Communication Skills, Executive Leadership, and Career Growth for Physicians by Neil Baum, MD.