Improving by "giving up" skill: Lessons from Tabla in Medicine

Several years ago, I had the opportunity to spend a few hours learning Tabla from a senior disciple of the instrument. At that point, I had been playing for several years and had reached a point where I was able to confidently and accurately play at a certain technical level. That day, we were playing kaida/paltas, a rhythmic theme upon which additional variations are introduced.

As we continued playing, the variations gradually progressively more technically complicated, and I distinctly remember feeling as if I was using my full technical ability to be able to match the instructor beat-for-beat while playing along.

At the end of the session, the instructor shared some feedback, including something he had learned from his guru. He encouraged me to focus less on absolute technical precision and play a little more “openly”, even if it came at the expense of losing some accuracy. To paraphrase his words —

Every once in a while, once you have progressed technically, you need to “loosen up” and give up a little bit of skill to be able to get to the next technical level. People often think that making progress is linear:

In fact, progress comes in waves, consisting of technical progress, followed by some regression of skill as you “loosen up” — which is an important step that is necessary to get to the next technical level:

I’ve been thinking a lot about this lately — and how this lesson fits in the broader scope of my life — especially in the context of my education as a third-year medical student. The scope of clinical education during the first two years of studying medicine largely consist of learning the fundamentals of patient interaction: how to interact with patients, organizing a patient presentation to discuss with attending physicians, a checklist to follow when collecting patient histories. As helpful as these tools are for ensuring essential information is gathered and conveyed to patients, “sticking to the script” we have been taught yields an undeniably less personal connection to the patient as a healthcare provider.

Now that I’ve been at the hospital full-time in my third year, I’ve made a conscious decision to try and “loosen up” with respect to my clinical skills as much as possible, in an effort to be more personal and more intentioned with how I approach patient care. Rather than going in to a patient encounter with a checklist I have memorized or present a case like I am reading a textbook, I try to look at the broader clinical picture and the individual patient, and try to approach it the best I can.

Has this actually helped? In some ways (especially early on), there has been an element of “regression”. By not sticking to an exact checklist and communicating more naturally, I will invariably miss some details I would have otherwise covered. On the flip side, there are many such details which are pertinent to some cases and irrelevant to others, and part of the art of medicine is distinguishing between the two. Moreover, I have found that communicating patient information to physicians, as well as learning from physicians, is much clearer and intuitive when I think about the topic as a narrative rather than a roadmap. Probably most significantly, I have finally begun understanding and appreciating the field of medicine, rather than a collection of facts.