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Beginner’s Mind

Posted By Margaret Kim Peterson, Wednesday, October 5, 2011

A month into the internship, it’s hard to know where to begin in sorting through the experience so far. Maybe the most obvious place to start, then, is with the experience of being a beginner. It’s an experience I haven’t had in a long time, at least not with anything so central to my sense of self. It’s one thing to take up a new hobby. It’s quite another to take up a new profession. All kinds of things that for a long time I’ve taken for granted aren’t there any more, and I really notice their absence.

Status, for instance. As a college professor, I walk into a classroom and introduce myself: "I’m Dr. Peterson.” As a behavioral health intern, I follow someone else into an exam room and am introduced: "This is Margaret, one of our students.” Soon, of course, I’ll be walking into those exam rooms by myself, but I’ll still be Margaret-the-behavioral-health-intern, never "Dr. Peterson.” I like to think of myself as not particularly status-conscious, but what is evidently closer to the truth is that I’ve become so used to my status that I don’t notice it—until it’s stripped away.

Then there’s competence. I’m a big fan of competence; I admire it in other people, and I enjoy it in myself. That’s missing, now, too (in me, that is). After fifteen years as an academic I’m used to knowing what to do and what to say, in person or in writing, at least most of the time. Now I follow my supervisor around, observing as she interacts with patients and providers. And guess what? A medical office is not academia, and much of the time I find myself wondering what on earth I would do or say, if I were on my own.

And then there is that subtler dimension of competence that goes beyond knowledge and skills to what one writer calls the integration of intuition and reasoning.1  Anyone who has to perform complex tasks in the midst of many competing demands learns to rely on automatic, intuitive decision-making processes. Sometimes, though, autopilot isn’t good enough; conscious attention is required, because something unusual is going on and needs to be responded to intentionally and creatively. As a teacher and advisor, I’ve gradually developed this capacity. How long is it going to take me to get there as a behavioral health consultant?

I wonder about this particularly because this kind of integrated flexibility is something that in the past I have developed more or less by accident. In my first experience of graduate education it was not recognized as important, let alone deliberately cultivated. (I think this is true of most Ph.D. programs, and it is one reason such programs are better at producing good scholars than they are at producing good teachers and advisors—teaching and advising require this kind of integration in a way that "pure” scholarship does not.) This time around, I’d like to be more intentional about it—but what exactly will that entail?

I do know where to begin in acquiring knowledge and skills. There are books to read (on the practice of primary care mental health, on motivational interviewing, on psychopharmacology, on the variety of conditions commonly or less commonly encountered in primary care). There are examples to follow (like that of my supervisor, Suzanne) and conversations to have (with Suzanne, with my fellow interns, with the medical providers and the rest of the clinic staff). And of course there is no substitute for just getting started, making my own mistakes, and finding out what I do know and what I need to learn.

Where status is concerned, well, I’ll never have any, at least where the hierarchy of the clinic staff is concerned. But perhaps there are opportunities in that ego-deflating fact. There is something about status that creates a temptation to relate to others from a position of power and to fail to notice how this shapes (and possibly distorts) relationships. Perhaps part of my job as an intern and a beginner is to find ways to relate to patients and to colleagues that are informed more by the desires to learn and to be helpful than by the dynamics of power and status.

This impulse, it seems to me, is at the heart of successful collaborative practice, in whatever discipline. Professionalism and competence, desirable and necessary as these are, can exert a pull toward independence and isolation. After all, if I know what I’m doing, why consult with other people? Collaboration, on the other hand, requires an openness to the possibility that we all have things to learn, things to give, and things to gain in working with each other. What those things are emerges only in the process of collaboration—which can be unsettling, exciting, or both.

1Lichtenstein, A. (2006). Integrating intuition and reasoning: How Balint groups can help medical decision making. Australian Family Physician 35, 987-989.

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Peter Y. Fifield says...
Posted Thursday, October 6, 2011
This is such a great post Margaret. It reminds me of one interpretation of the "fifth" and highest level of integration proposed by Doherty, McDaniel, and Baird where there is no status issue. The fifth level is a place where mental and medical are equals, all are collaborating, side by side and no one is trying to lead the way.
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