By Dr. Joseph Hawkins, Consultant in Palliative Medicine, Ashford and St Peter’s Clinical End of Life Lead, Ashford and St Peter’s NHS Foundation Trust. Twitter: @JoeHawk75825077

Cleverness is a very human attribute. When we talk about animals being clever we don’t really mean that they are smart we mean that they are showing an ability to learn or to solve a very simple problem. The person devising the problem, the experiment and the inevitable scientific paper, they are being clever. The proverbial mouse in the maze just wants his cheese, ephemeral dreams of academic luminary praise are not for the mouse.

However, cleverness is not always all that it’s cracked up to be. Take a simple observation, we should probably all exercise more. Now the wise response would be to undertake social prescribing schemes for all, to make cycling easier and incentivise the population to become weekend triathletes. The clever response, the very human response, is to look for a pill that can do this. As I write this article- uncountable financial resources and brilliant minds are at work trying to discover how to turn us all in to couch potato, pill swallowing, cardiovascular marathoners. The nirvana of being able to eat all of the crisps that you want whilst watching strictly come dancing and still have the heart of a racehorse on steroids is only one discovery away.

So it is with much of medicine that we delight in our mastery of the clever. Every day I see colleagues squinting at screens, their patients washed out by numbers as they lie, mutely awaiting the next infusion of clever drugs for their chest pains, coughs and burning loins. Yet, somehow, many of our  patients don’t get better despite our clever interventions.

The recent Lancet report on the value of death¹ observes the increasing medicalisation of dying. This medicalisation of the end of our lives is part of an illness of cultural attitudes and cleverness may be our biggest barrier as we forget that cleverness and wisdom may sit in their own Venn diagram but not all decisions lie within the centre of these two spheres.

The solution to it all seems embedded in the clinical mantra of: ‘common things happen commonly’. Dying is a common thing; and a large part of my job as I visit patients every day who are dying, seems to be to remind and support my colleagues in remembering this fact of life.

I don’t consider myself wise, or even particularly clever, but I do see that there is wisdom in looking beyond the clever fix and considering whether the bigger problem needs a gentler, less medical and ultimately wiser approach. I often ask myself and my colleagues this question.

Recommended reading:

How To Tell if Your Patient is Dying.

https://blogs.bmj.com/spcare/2021/08/12/creative-distress/

References:

1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02314-X/fulltext