By Eve Purdy (@purdy_eve)
I just moved to Australia for an education fellowship and to work on research in the anthropology of trauma care provision. So far so good. I quickly became accustomed to the fact that Aussie’s shorten everything from the word afternoon (arvo) to ambulance (ambo). As a Canadian, I take kindly to the balmy 23 degree “winter” on the Gold Coast. The coffee, and deliberate way that it is consumed, is also to be admired. Overall, there seems to be many more similarities than differences between our countries. However, there has been one, very unexpected, reality.
I have been totally shocked by the amount of brain energy I expend trying not to die.
Before I departed, I read about snakes and spiders. Much to the amusement of a couple of my friends here, I even wondered out loud about whether they use “snake bells” the same way we use “bear bells”. As it turns out, they absolutely do not. This spring, I almost ordered the book “1000 Ways to Die in Australia: Travels in the Aussie Outback”. I figured that as an emergency medicine resident I should be vaguely familiar with all of the poisonous things that might kill me and my patients. While getting ready for this adventure, I spent a good deal of time reading, so as not to die when I arrived. I was ready.
I stepped off the plane, collected my bags, made it through customs, went outside, looked left, and stepped off the curb. I still am shocked that the white ute (pick-up truck) didn’t hit me. My Australian adventure nearly ended just as it began.
This didn’t happen just once. It has since happened repeatedly. First as a pedestrian, then as a cyclist, then again as a driver. As the weeks have gone by, I have adapted to life as a driver and as a cyclist on the left-hand side but I have found that I still frequently almost die as a pedestrian.
While regaling these tales to friends and family back home, I was struck by the number of times I heard the term “driving on the ‘wrong’ side of the road”. Even as an anthropologist, the phrase slipped out of my own mouth once or twice. I still sometimes find myself internally cursing at people coming towards me on the “wrong” side of the sidewalk.
Why am I telling you this story? The experience has left me with a couple of reflections that may be relevant to medical audiences.
- It would seem that the simpler, the more ingrained, the more fundamental, the action the harder it is to adapt to a different way of doing.
- The term “driving (or walking) on the ‘wrong’ side” highlights a natural gravitation towards ethnocentrism. In this case it is a bit funny, and relatively harmless, but does signal to our natural human tendency to assume the way that we do things is “right”.
Until these recent experiences, I don’t recall a time that I can remember focusing or even being aware of my walking. The same is not true for cycling or driving. Though often automatic actions, even in Canada they do occasionally require a degree of thought. This required awareness allowed me to adapt more quickly to these activities. Unfortunately, the same processing has not occurred for life as a pedestrian.
As we learn medicine, we entrench behaviours and ways of being early on. We are indoctrinated into a way of seeing and existing in the medical world. Some of this becomes fundamental to our day to day life as physicians – like walking is to many humans. Lots has to become automatic for us to function, but with that automaticity comes a potential lack of flexibility – or even awareness – down the line.
I would venture that these fundamental behaviours are learned primarily in clerkship and early residency, critical developmental stages. They are shaped by our mentors, teachers, the hidden curriculum, and the specialties we find ourselves in far more than they are shaped by lectures and textbooks. Only after we learn to professionally walk, do we add on complexity and nuance – like that of riding a bike or driving a car.
The development of inflexible foundations, paired with inherent ethnocentrism, makes for a potentially disastrous combination. I’m not sure what the exact professional equivalent of almost being hit by a white pick-up truck then being upset at the driver for being on the “wrong” side of the road is…but that is the risk that we run!
We are frequently charged to work with colleagues that have slightly different foundations than our own. We may even feel that they walk on the “wrong” side of the medical road. What seems obvious to an emergency physician, may be less so to a surgeon. And what seems obvious to a surgeon, may be less so to an emergency physician. The natural tendency, when someone is behaving in a way that is not the same as the way that we would, is to assume the other party is wrong. We automatically think that they are the ones walking on the “wrong” side of the road.
Though we may be unable to change our inflexible foundations, anthropology can help mitigate the complications of combining those foundations with ethnocentrism. Anthropology teaches engagement in reflexivity (reflection on one’s own positioning) while demonstrating curiosity about those you are surrounded by.
This is particularly useful to engage with when you sense difference (often experienced in the work environment as frustration, anger, or tension). Reflexivity and curiosity can build bridges over the inflexibility that our foundations set.
In my conversations with family and friends, I have now chosen consciously more neutral language. Instead of “driving on the ‘wrong’ side”, I say “driving on the ‘opposite’ side”. This subtle change in vocabulary requires that I spare automatic judgement and allows for the space to foster reflexivity and curiosity. When I do that, it is pretty clear that I am in fact the one walking on the “wrong” side of the road in Australia.
I get that this whole article may seem like a bit of a stretch. I wouldn’t blame you for thinking that “driving/walking on the “wrong” side” is a simple slip of the tongue that could have been spared all this reflection. The point however, is that commitment to reflexivity, true curiosity, and subtle changes in language can affect the way that we engage with difference and construct a future understanding. The more fundamental a behaviour or action, the more likely we are to be inflexible and the more dedicated we have to be to not jumping towards immediate judgement.
I didn’t anticipate that my first Australian near death experience would be at the hands of a pick-up truck or that I would learn so many lessons from it that are unrelated to venom.
Interested in your thoughts on walking on the “wrong” side of the road in medicine and life. Please feel free to share below.
Feature photo provided by author