Guru or Geek?

In the past couple of months, there was a minor news item about a health care-based study. Those of us “in the trenches” hardly considered it news, as might the general public when confronted with yet another headline proclaiming -shocker!- that eating less and exercising is a good way to lose weight.

The upshot of this piece was that, when providers of health care focus on satisfying patients rather than doing what’s medically appropriate, outcomes suffer. I don’t remember the details of the piece, and can’t seem to track it down currently (although a satirical piece more recently mocked it in a funny-cause-it’s-true move).

I suspect another effect of favoring appeasement over good medicine would be greater expenditure of resources (manpower, medications, etc.). A common example would be an ER doc, seeing a sniffling kid and recognizing a routine viral infection, knuckling under and prescribing an antibiotic lest the parent get angry and ultimately ding the doc’s Press-Ganey stats.

It put me in mind of a thought I’ve had for some time as to how possessors of rare knowledge or skills deploy their gifts. It’s probably more of a spectrum than a dichotomy, but it seems to me that folks tend towards one extreme or the other: gurus or geeks.

A classic geek would be the brainiac in a grade school classroom. He’s got capabilities others around him do not, and they have more than occasional ideas about how he might share his gifts - anything from doing their homework to being a source for cheating on exams. The geek might or might not want to cooperate. If he does, it’s often for fear of what his peers will otherwise do, from physical threats to psychological bullying to simply not being his friend. The geek allows his possession of a precious commodity to place him in a subservient role.

The guru is also highly intelligent and/or experienced, and also sought out by others for his gifts. However, he knows what he has to offer, and does not cheapen it by practically begging his audience to make use of him. He does not fret that others will fail to notice him, but rather exhibits a calm confidence, which serves to underscore just how much of a guru he is. People seek him out, and are grateful for the time and effort he gives them.

Physicians, especially those in competitive or rare specialties, are in prime positions to be gurus or geeks. A typical day of work brings constant opportunities to choose between these archetypes. Sometimes, there is no conflict; for instance, one may diagnose a pulmonary embolus and promptly call the referrer. One’s inner guru might be satisfied at having done a good job as a reliable expert, while one’s inner geek might be pleased at the notion of being held in higher regard by the clinician.

On the other hand, there are plenty of crossroads where it’s not so win-win, and the geeky path is often the one with less resistance. Indeed, it seems the health care system is set up to make it so, as with the ER doc’s struggle with Press-Ganey metrics referenced earlier.[[{"type":"media","view_mode":"media_crop","fid":"28614","attributes":{"alt":"geek or guru radiologist","class":"media-image media-image-right","id":"media_crop_2420169345567","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2918","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 128px; width: 161px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

Radiology residents get an early education with this when on call, as they try to protocol (or sometimes deny) studies based on appropriateness criteria they have been taught during their daytime training…and more often than not, if clinicians are displeased with the rezzies’ fledgling efforts at being gurus, the radiology attendings’ take-home message for them is something along the lines of “just give them whatever they want.”

The fears motivating radiological geekiness are not without foundation. Yes, it’s true that failing to cave in and do the bidding -however inappropriate- of clinicians, administrators, or regulators could result in losses of referrals, interdepartmental goodwill/clout, and bureaucratic hassles. On the other hand, geekiness begets more geekiness, as those who see you knuckle under today will expect more of the same tomorrow. Further, geeky behavior from some in the field can create expectations of similar meekness from others, in a sort of inverse herd immunity.

It’s tougher to be a guru. You have to be good at what you do; otherwise, there’s no reason to seek you out as opposed to a geek with equal or greater capability who will be more of a pushover. Further, whatever surplus of skills you have stands to be counterbalanced if you are less than diplomatic and graceful about it; being cocky, arrogant, etc. will go a long way towards convincing folks that your obnoxious brilliance might just be replaced by a slightly less brilliant geek who plays better with others.

Still, think for a moment of the radiologists (and other physicians) that have impressed and inspired you during your time in the field. Have they tended to be gurus or geeks?