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Creativity in Medicine

What defines creativity? Where does creativity come from? Where does it exist in medicine?

Tirone David
Tirone David
We were privileged to have someone who has been described as a creative genius enlighten us about these questions at a recent Surgical Services Rounds at the University Health Network. Dr. Tirone David, University Professor and Melanie Munk Chair of Cardiovascular Surgery at the Peter Munk Cardiac Centre, shared his unique insight on "Creativity in Medicine" to a rapt audience. Dr. David's long history of technical and conceptual creativity in cardiac surgery has had a profound impact around the world -- from introducing Gortex chordae tendinae in mitral valve reconstruction, to inventing new types of heart valves and a valve sparing procedure, to his infarct exclusion operation.

Creativity, according to Dr. David, involves two fundamental qualities. The first relates to genius theory, some innate quality in an individual that portends an intrinsic skill in a particular area. As an example, Dr. David cited Albert Einstein as a widely recognized archetype of genius. Interestingly, following Einstein's death, an examination of his brain revealed unique structural features that may explain his innate "genius". The second quality that defines creativity is the stepwise, logical evolution of ideas, products, techniques, and in the case of surgery, operative procedures that follows from the work of thoughtful and skillful individuals.

Was the discovery of the structure of DNA by Watson and Crick an example of creative inspiration? No. Dr. David used this discovery to illustrate creativity as a logical stepwise progression of ideas from individual to individual.

Starting from Oswald Avery's 1935 discovery that DNA is the material of which genes and chromosomes are made, to Chargaff 's discovery in 1950 that in natural DNA the number of guanine units equals the number of cytosine units and the number of adenine units equals the number of thymine units, to Linus Pauling's 1951 discovery of the alpha helical structure in proteins, Dr. David illustrated the logical progression of ideas that culminated in the next step: the discovery of the helical structure of DNA by Watson, Crick, Wilkins and Franklin in 1953. This sequence of events over decades serves as an example of Edison's description of creativity as 1% inspiration and 99% perspiration!

What describes creative individuals? They are skillful, self-motivated and knowledgeable, but those qualities alone are not sufficient. Creativity is something that not only has a flow, but is also judged within a domain, by a field of assessors, judges and peers who determine if an individual has demonstrated creativity. This process of judging creativity and discovery is clearly defined in medicine. The Nobel Prize winning discovery of Helicobacter pylori by Marshall and Warren aptly illustrates this process. In 1984, when Robin Warren observed small helical bacteria colonizing the antrum of the stomach in patients from which biopsies had been taken and signs of inflammation that were always present in the gastric mucosa close to where the bacteria were seen, he concluded that gastritis is a "bacterial disease". His peers did not believe him. However, when Barry Marshall, a young clinical fellow, became interested in Warren's findings and conducted a study including 100 patient biopsies with Warren, the findings were verified and finally judged by their peers to be a novel discovery that revolutionized treatment of peptic ulcer disease.

Creativity in medicine unfolds over time, a lifetime in most cases. Dr. David describes it as the synergy of many sources and not a product of a single mind. Why not? Because one cannot be knowledgeable in everything... Creative ideas are generated from the previous knowledge and experience of others and thus, creativity is in continuity with the past. Dr. David's passion for creativity is inspiring, as were his insights on creativity in medicine. We are privileged to have his creative genius amongst us at the university.

Mitesh Badiwala
Cardiac Surgery Resident

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