The Importance of Being Curious

A stand-alone attribute by most accounts, curiosity has much to offer the healing profession. Indispensable to any analytic efforts of a diagnostician, epistemic curiosity (also known as cognitive or intellectual curiosity) can hardly be overlooked. No other quality can be counted on to rationalize seemingly insoluble clinical constellations. No other trait is likely to connect disparate clinical dots absent a conventional roadmap. Viewed in this light, curiosity constitutes an elemental trait of the practicing physician. A recently developed database of physician attributes reached similar conclusions.¹ Nonconforming and probing, curiosity is the long-lost universal antidote to the familiar admonition “when you hear hoofbeats, think horses, not zebras.” Horses may indeed abound. Zebras, however, have hardly gone extinct. In this Commentary, we explore the indispensability of curiosity to the practice of medicine, review existing approaches to its quantification, and explore its potential inculcation into contemporary constructs of medical education.

In his 1954 treatise on human curiosity, Daniel E. Berlyne defined epistemic curiosity as an omnipresent “drive reducible by knowledge-rehearsal.”² An all-too-human urge to investigate, seek after knowledge, and engage in exploratory behavior, curiosity was deemed to be a primal habit of mind. Perceived in this fashion, curiosity is closely related to, if not synonymous with, the notions of inquisitiveness, reflection, and mindfulness. Additional insights offered by common behavior theories suggest that curiosity is strongly driven by an undesirable state of “uncertainty” that must be relieved. Any loss or disruption of a state of coherence may be assumed to unleash a curiosity drive with an eye toward restoring normalcy. Adaptive, redemptive, and resilient, curiosity is widely regarded as a vital and irreplaceable human asset.

Largely overlooked during the bygone eras of dogmatic and empiric medicine, curiosity emerged in earnest as a corollary of medicine anchored in contemporary science.³ An outgrowth of the Flexner Report, curiosity proved central to the parallels drawn between the art of medicine and the scientific method.³ No other attribute could underlie the “powers of observation” that “frame a working hypothesis, now called a diagnosis.” No other habit of mind could serve as the “starting-point . . . to comprehend and to master the abnormal.” Examined in this fashion, curiosity, the driving force behind the progress of science, plays just as important a role in the “intelligent practice of medicine.” Upholding and nurturing this central attribute rests with the institution of undergraduate medical education wherein “the student must be trained to the positive exercise of his faculties.” It was Flexner’s unshakeable conviction that the exercise of curiosity is inextricably linked to the art and science of medicine.

Recent position statements of leading medical-education enterprises suggest that convictions as to the import of curiosity remain strong. A joint report of the Association of American Medical Colleges (AAMC) and the Howard Hughes Medical Institute (Scientific Foundations for Future Physicians) identified curiosity as “fundamental to the practice of medicine.”⁴ A more recent report of the of the Behavioral and Social Science Expert Panel of the Association of American Medical Colleges (Behavioral and Social Science Foundations for Future Physicians) credits curiosity with the conduct of “socially informed and psychologically aware medicine.”⁵ Curiosity was also touted by the American Council of Graduate Medical Education (ACGME), which defines the self-directed lifelong learner as “one who . . . has a high degree of curiosity.”⁶ Faculty role-modeling of the “joy of curiosity” was similarly emphasized.⁷ Mission statements of multiple medical schools have articulated comparable sentiments. In the eyes of one observer, the development of “epistemic curiosity should be a core part of learning and teaching in medical education.”⁸ Yet others spoke to the “duty . . . to identify medical students with a gift for curiosity and take infinite pain not to suppress but to encourage that gift.”⁹

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-Eli Y. Adashi, MD, MS^a, Abdul-Kareem H. Ahmed, SM, MD^b, Philip A. Gruppuso, MD^a

This article originally appeared in the June 2019 issue of The American Journal of Medicine.