"TMI"

Is there such a thing as "too much information?" I've been asking myself this question for a week now (and, on some level, for the past six months), and decided that it was time to write about it.

The other night, a friend of mine told me that the physician for whom she works came out of a examination room exclaiming, "TMI!" -- presumably after hearing some kind of uber-personal story from his gastrointestinally afflicted patient. My friend felt embarrassed because she'd never heard the expression before ("Too Much Information"), and thus didn't recognize it. It was clear to me that one reason she'd never heard the expression is because, for this friend (and for me), the concept just doesn't exist.

I can't remember a time, both in my personal and professional life, that I've ever been put-off by a human being's personal disclosure about something intensely intimate, awkward, or "disturbing." In contrast, I experience these moments as tremendously rewarding -- the privilege of being trusted with the intimate details of a person's life, the profoundness and depth of the responsibility that comes along with it. It's a huge deal to me. When it happens, I'm very mindful of its significance -- even if that significance is not attached by the disclosing party -- every single time it happens, and it ALWAYS surprises me: a casual acquaintance, a research patient, a Spinning student. It's always special.

This isn't necessarily a great quality of mine, actually. Part of my appreciation for the "specialness" of those moments is that, admittedly, there's a layer of grandiosity that reflects that I actually DID something to earn that trust. Maybe I did -- but, mostly, I didn't. Sometimes people just have something to get off their chests, and I happened to be standing in front of them when they needed to air their thoughts. And, actually, when I am QUITE certain that I absolutely, definitively did NOT do anything to earn someone's confidence, I don't feel so rewarded. Do I gasp "TMI!" -- of course not. I'm still not off-put. But do I feel warm, fuzzy and proud of my listening and confidence-inspiring skills? Absolutely not.

There's a fine line already, and it's going to get tricker to distinguish. I've written a lot already about the very strange, unnatural "access" to people afforded to me by my status as a medical student (which will drastically increase in two weeks when I officially am awarded my white coat). I accept that, even more so, people are going to want to tell me stuff. Am I afraid that the sheer frequency of these events are going to in some way kill the novelty? No, actually. People have been telling me stuff for the past 25 years, and it hasn't gotten old yet. But SOMETHING will be different. How can it not be? So I'm giving some loose thoughts to exactly what that "something" might be, is all...

Not all disclosures carry with them an attempt for a solution. Sometimes people just want to vent. One of my character flaws that I've spent a lot of effort working on over the past few years is that I inappropriately pose potential solutions within contexts that did not seek them. I had an old boyfriend who used to call me out on it a lot: "I'm not telling you this because I want you to do anything about it. I'm just telling you for the sake of telling you!" I didn't get good at shutting down that default interpersonal style until I started coaching, actually. When I wear my "coach hat," I primarily ask questions designed to help an athlete use his (or her) OWN mind clearly -- to arrive at his own questions, even. The way I see it, people arrive at their own solutions when they ask themselves the right questions. So that's what my questions are designed to do. When I take my coach hat off, though, I don't always carry myself the same way -- and I should!

But when I wear that coat, the context is going to change. The expectations are going to change. More often than not, disclosures will come attached with a pursuit of resolution. At first, I'm going to have maybe a 0.05% improvement over my lay abilities to be helpful to a person. My white coat would reflect otherwise -- but at the end of the day, there will be absolutely no difference in my knowledge base between February 19 and February 20 (White Coat Ceremony).

The intensity of those disclosures may also change. Up until now, "confidentiality" has been an implicit value. When I have that coat on, it's a legally binding value. What impact will that have? I don't know. There have been plenty of times when I was not so moved to disclose even medically relevant details to my physicians, simply because I didn't "feel" it. Assurance of confidentiality has played almost a 0% role in those decisions of mine. The implicit values -- lack of judgment (my top concern!), skewed interpretation, general approval-seeking -- have carried the day, for me at least.

Approval-seeking behavior is the value I think about the most. I've absolutely withheld details from my doctors over time, particularly when those details were really damned relevant and I knew better. How am I going to tease that apart from the other end? No matter how non-judgmental I can convey that I am, that's always going to be an issue of which to be mindful.
To some level, that white coat is a burden. People don't try to please me now; they're honest. "It is what it is" -- unless you're wearing a white coat.

Everything I've said thus far would reflect an unconditional belief that there is no such thing as "too much information," independent of source or purpose or context.

But that's not actually how I see it.

Now, this blog is not supposed to require disclaimers, I now appreciate that there are a lot of people who actually read this (even people whom I've never met, which is incredibly humbling and worth the occasional mindfulness of my audience-less reflections actually having an audience). But alas, a disclaimer: what I'm about to say is going to sound AWFUL.

One of the most profound shifts since commencing my medical education is what I call an acceptance of mediocrity. My first 1.5 years of training are graded on a Pass/Fail/Pass with Honors scale. What that means is that a 75 is the equivalent of a 92. Except that guy with the 92 GPA isn't teaching 4 Spinning classes a week, reading for pleasure every night, maintaining two blogs, exercising, cooking, or spending hooooooooooooooooours investing in her interpersonal relationships. And I am.

Adopting a "bare minimum" mentality actually requires a lot of self-discipline -- and I will go so far as to argue that it requires MORE self-discipline, in that it requires a deliberate suppression of one's curiosity. By aiming to know big picture concepts that can be practically applied to clinical situations upon recognition of key starting frameworks -- and to learn how to go about looking up all the details in between when they're needed, as they're needed -- you are essentially disciplining yourself to not learn as deeply and thoroughly as you've ever learned before... or ever imagined yourself learning. Today, for example, I had two hours of lecture on hypersensitivity/allergy. Totally dig it. Had relatively intelligent questions beyond the scope of the lecture... Googled what I could, but then deliberately didn't take it to the next level of asking the lecturer. I know that my brain needs priorities. And this wasn't one of them. Big picture = PASS + maintain mental clarity and perspective.

The difference, I think, is that here "bare minimum" is actually a RIDICULOUS volume of specific content. It's just, obviously, not everything that one could ever learn. How could it be? So "slackerdom" equates with an insane amount of learning. But am I mindful of how purposefully non-inquisitive I am? Absolutely. Does it bother me? Sometimes it kind-of does.

Even "too much information" isn't enough information. It's just a question of what's worth-it. Input vs. output. Expected payoff, predicted on the basis of something you don't actually know anything about. Everything's a gamble...