“Imagination” isn’t a word that often comes to mind when we think of medicine, but every good doctor possesses it. The realities of being a physician are so far detached from the medical dramas in which a group of doctors gathers around a white board to determine a single diagnosis, administer a single medication or perform one operation which instantly cures a patient who had been near death. Real medicine is untidy by comparison and many times tedious and ambiguous. The medical process is bound by procedure, ethics, and, unfortunately, legal defensibility.
Despite how uncreative the practice of medicine can seem, however, imagination is critical to being a good doctor. Through our education, we must build a mental image of the human body and its amazingly complex function. It is in the arena of imagination that we test and interact with this model, interrogating various therapies and their consequences before administering a single dose of real world medication.
Imagination is also the gateway to empathy. We must use our imaginations to walk in the shoes of our patients and try to understand their sometimes inconceivable experiences. Only through imagination can we truly relate to those under our care, address their fears and their pains, provide meaningful communication, and transcend the boundary from technician to healer.
As a society, we would do well to learn the lessons of imagination. The COVID pandemic has affected us all in innumerable ways, and it is a great failure of imagination that has divided us so bitterly. When we refuse to imagine a life other than our own, we lose the ability to relate to those without our same exact experiences and, consequently, the ability to find common ground.
Conversely, when we allow our imaginations to transport us into the lives of others, we quickly see that many of our seemingly self-apparent notions of truth and rightness are actually selfish and limited. Imagination may not immediately yield a correct answer, but it can certainly expose the frailty of things we previously took for granted.
Imagine a man who lost his business to the lockdowns of last year. Watch the news through his eyes as the very laws which ruined his life’s work are met with approval and applause, all to fight an illness which has never affected him. Ask if he is unjustified in his resentment, or that he is wrong to say that we should shelter those most susceptible so that the rest may have their livelihoods.
Imagine a woman on immunosuppressant medication for a kidney transplant, critically ill from COVID despite three doses of vaccine, her worst fears realized through no fault of her own. Watch the anti-mask demonstrations and hateful backlash against vaccination through her eyes and ask if she agrees that society should isolate the vulnerable so that the rest may live normally.
Imagination can be uncomfortable. It opens the doors to doubt and uncertainty, and for this reason many choose to shun it. In medicine, a physician with a robust imagination can foresee the worst possible outcomes for the most benign treatments. There can be a certain paralysis that comes with the knowledge of so many eventualities.
But imagination is also our probe into the future. The false confidence that comes with the ignorance of possibility can never yield a wise course of action. When we allow ourselves to imagine the many branches of the path ahead, we can best prepare ourselves for any of them. As physicians, if we make our decisions now with a full realization of where they may lead, then in hindsight we cannot have regret. The same is true outside the hospital as well.
Imagination is the way to a better tomorrow. As physicians, we imagine a sick patient well and healthy, and ask ourselves, what is the path from here to there? As a society, our collective imagination can hold up the goals of what we may achieve: equality, opportunity, wellbeing and peace. When we can visualize this ideal, we may subtract away the progress we have made thus far and the difference is the work left to be done.
Imagination keeps our heads held high and our gazes forward. Imagination preserves our nobility such that we can picture ourselves as we want to be, even when we are not, as individuals, professionals, and as a society. When we lose this capacity, we give in to our selfish instincts and allow ourselves to fail our own standards. As physicians, when we are no longer capable of viewing ourselves as competent, we can no longer be so. Fittingly, it is imagination and the ability to foresee the consequences of our failures that keeps us humble.
Through the traumas of the last two years our imaginations have sustained us, whether it was visualizing an end to the pandemic, or simply wishing for a night out with friends. As we move forward and hopefully beyond COVID, we will need our imaginations again, not to distract us, but to guide us and inform us of the world which we must build.