The climate of polarization has taken over the world in recent years. This constant Fla X Flu, it seems to only get worse, more serious. For centuries there has been a fervent dispute between divergent economic models and those who argue are no longer concerned with reaching conclusions that are productive for everyone, but with making it clear that one side is right and the other is wrong – in fact, nobody wants to admit that they are. wrong. This pattern accompanies many other discussions, whether in the private or professional sphere. The debate turned from a conversation into an elaborate battle, separating winners and losers. And so our ability to listen to different and divergent points of view and, with it, our ability to learn through dialogue is diminished.
Radiology does not escape this dispute. Check this one out example: when a radiologist performs an examination, he finds unexpected anomalies, unrelated to the purpose of the examination. What he does? Do you pass on only relevant information to the patient? Or do you order additional tests, no matter how small or insignificant the abnormality detected on examination appears?
It is very common for imaging tests to detect abnormalities that are not necessarily signs of disease. What researchers want, through dialogue, is to work towards establishing standards, including ethical ones, about what should be said to the patient and what would justify a deeper investigation – it is even worth resorting to dozens of exams if the anomaly does not indicate risks to the patient?
It's not a simple discussion. Each side resorts to its own arguments to defend its point of view. Regardless of each side's opinion, the important thing should be to listen to all the arguments, given that, in the end, it is the doctor who will take a position with his patient, and this position must be the best possible.
“We have ample opportunity to engage in the practice of presenting arguments, but apparently we need more practice in answering them. Because regardless of whether our reasoning constitutes genuine, rational deliberation, or is an example of rationalization, that is often not what we want to do.”, he writes Daniel Cohen, philosopher specializing in argumentation theory. “We can be very effective in the practice of presenting arguments; we are not so good at understanding other people's arguments. We are not as receptive to reason as we think we are.”.
There is not much secret in what motivates us to be like this. It is more comfortable confirming our own convictions. Better, therefore, to argue to the limit (and become champion) than to listen to the other's counterpoint – and, in a way, to agree and rethink your own point of view. “Skilled arguers, however, are not after the truth, but arguments that support their points of view. This explains the notorious confirmation bias. […] Reasoning used proactively also favors decisions that are easy to justify, but not necessarily better ones”, defend researchers Hugo Mercier and Dan Sperber.
In an interview with the NY Times, Mercier he spoke on the evolutionary function of the development of reasoning. “Debating is not meant to help us arrive at better beliefs and decisions,” he said. “It is a purely social phenomenon. Evolved to help us convince others and be careful when others try to convince us.”
This encompasses all aspects of our life. Including the medical field, which lives in constant updating, and is born from the scientific method. Science needs to go through the formulation of hypotheses, tests and experiments to prove it, as well as go through the analysis and proof of the technique (or theory) by other specialists to reach a conclusion. Even so, this process is full of controversy – and polarization. See, for example, the controversy surrounding the use of medical marijuana in the treatment of various diseases, among other controversial issues. After all, why should we pay more attention to a radiologist who uses different methods? Why should we open ourselves to dialogue, with a real interest in someone else's argument, and not in search of argumentative victory?
reason and argumentation
This discussion comes from a long time ago. Around the year 400 BC, Plato already studied the power of rhetoric, of this intense search for victory in a discussion – and not the exchange of knowledge, based on the content, and not on the form of the speech. At that time, some Greek thinkers used language as a pure and simple form of power. They were skilled orators who, in exchange for money, taught their apprentices how to convince and win arguments. For them, any opinion was valid and defensible – even if it was not based on truth or scientific evidence (as currently flat-earthers and denialists do). The form mattered much more than the content. It was a game. And the Sophists taught how to win.
Plato became a staunch critical of the sophists – language should be an instrument for discovering knowledge and reality, not a product. According to him, the good use of rhetoric should favor rational discussion, respect ethical principles, recognize the interest in the rational discussion of problems as a way of defining the truth. But what is the truth? It is what reason can capture. For him, belief trumps assumption; and only scientific knowledge overlaps the two. In common sense, according to the philosopher, the argument comes from perception, not from reason.
To arrive at knowledge, however, Plato did not rule out the other. On the contrary, he believed in dialogue as an essential principle for human development.
The importance of dialogue
Martin Buber, throughout his life, sought to inspire mankind to to listen the other. Journalist, philosopher and theologian, he defended the harmonious and peaceful coexistence between Arabs and Jews, at the time the State of Israel was built.
For him, dialogue was a fundamental part of human relationships. “A real conversation, and at the same time every achievement resulting from the relationship between people, means the acceptance of the other”. He believed that only this exchange of ideas would make someone stop seeing only themselves and start seeing the other. He also emphasized that, in a real dialogue, there would be no room for someone's domination, victory or elimination.
Already at that time, Buber saw this true exchange as impossible. He was betting, however, on the need to restore this human ability to dialogue – with mutual listening. In this case, there would be a difference between talking with the other and for the other. The first constitutes dialogue, generates a true connection and exchange. A real debate.
A healthy way of debating
Every debate must have a well-structured argument, based on science and evidence. It is when two sides, with different, even opposing points of view, present and study ideas – not people or events. When they realize that there can always be different perspectives, in search of building a deep and mutual knowledge. A debate turns conflict into learning and strengthening relationships. From this discussion, built on listening and rational argumentation, they reach a consensus.
But what is a consensus anyway? It is a common agreement, necessary to formulate practical recommendations. The German philosopher Jürgen Habermas defined “communicative action” as interaction aimed at understanding, without coercion or manipulation. And it is from there that consensus is reached, based on rational arguments. Not that you have to agree with everything. Dissent is also part of the dialogue process.
Think of the evolution of imaging technologies. There was (and still is) controversy regarding the use of some techniques in patients with different diagnoses – which one works best for certain cases? Or even the incorporation of new technologies – is it really worth investing in that expensive device, while other techniques work just as well, without weighing on the patient's pocket, without burdening the public health system so much? There is only one chance to move forward: with dialogue, with exposure from different specialists, each with their own practical experiences. Between agreements and disagreements, at some point, the discussion evolves into a consensus – which may or may not be followed.
Consensus formed from the arguments of experts involves the combination of judgments, reflections and analysis of data and experiences. Best practices in the medical field, which become standard, leave this context. This “agreement” generates a new path, a solution. Returning to Daniel Cohen, he observes that when one side listens to a different argument – and learns from it – everyone wins. Just think of the cognitive work during these dialogues. Our brain always tends to save energy. No wonder, the simple act of tracing new paths home, or to work, requires more attention and brain work. When we go through the same streets, or repeat recurring actions, such as changing the gear of the car, the brain turns on autopilot.
In practice, most of the time, the brain uses past learning to understand the world – that is, it cuts corners, which can lead to confusion during a dialogue. “The brain always conserves energy. That means he takes shortcuts. I may be making clear mistakes with you in thinking you understood. You, as a listener, may be making mistakes by assuming you understand something. Even on good days, our verbal communication is poor and we disagree all the time. This just speaks to the imperfection of human communication around the world.”, explained psychologist and researcher Stan Tatkin, in an interview with Time magazine.
In addition to disagreements, listening to the other and changing your mind requires much more of our brain. A greater expenditure of energy to evaluate the patterns already known – or the pre-drawn paths –, to question them and to evaluate if rethinking certain positions makes sense or not. But there are gains: these new paths also generate new cognitive connections, which form new learning – and nothing more important than the construction of new learning within an area in constant evolution such as radiology; after all, how to learn with so much new information if not through dialogue?
It turns out that to reach a rich discussion an important technique is needed: active listening, that is, with real interest in the other. It's no use just listening, without attention, and shutting up. It takes understanding of the other. By the way, medical researchers give the term another name: therapeutic listening. And they judge it as essential in medical practice. “Listening presents itself as an essential communication strategy for understanding the other, as it is a positive attitude of warmth, interest and respect, thus being therapeutic”, write nurses Ana Cláudia Mesquita and Emilia Campos de Carvalho. “The use of listening starts to value the person as a subject who seeks and is capable of developing. Therapeutic Listening is appreciated by several psychological schools and by common sense, representing the basis of all responses that effectively generate help. In care, listening can minimize the anguish and reduce the suffering of the person assisted, because through the dialogue that develops, it allows the individual to hear what he is saying, inducing him to self-reflection”, they conclude.
In a discussion with professional colleagues, when we practice the exercise of active listening and dialogue, we are forced to review concepts, rethink already common points of view. Active listening is not just about being silent while the other person talks. It means showing interest. And that brings effort and cognitive gain – it forces the brain to turn off autopilot.
This construction of the debate feeds critical thinking. That is, the ability to make decisions in the face of a new situation. This is what happens in radiology when interpreting exams or suggesting different technologies for each patient. This requires some qualities: capacity for analysis, communication, creativity, open mind and ease in solving problems.
All these characteristics coincide with the good practice of debate. A person with critical thinking must know how to evaluate data and research, question evidence, recognize patterns, listen actively, know how to express themselves, seek new knowledge, have a keen curiosity, work well in a team, innovate. Always guided by reason and science.”To think critically, you must put aside assumptions or judgment and simply analyze the information you receive. Need to be objective, evaluate ideas without bias”, he writes the American Alison Doyle, from the University of Indiana.
Debates based on critical thinking can be used in any field – but in the medical field it is even more fundamental. For more than four decades, the practice clinical practice takes years to consolidate itself in standard procedures, built over years of studies, taking into account scientific evidence and the construction of consensus among specialists. But technology, especially in radiology, undergoes constant revolutions. It is so much new that the researchers do not manage to present rich methodological studies to determine the best uses for each one of them.
“Use has been driven by methodologically poor reports, which tend to exaggerate the performance of new techniques, further encouraging their diffusion and use. The end result is the suspicion that expensive technologies such as CT and MRI are being used more often than necessary despite cost-effectiveness for the customer.”, reports radiologist Bruce J. Hillman.
Arena Point and Counterpoint for thinking, argument and learning
The importance of the debate among radiologists is that it stimulates the development of critical thinking and active listening, favoring learning. Those radiologists who have systematized critical thinking in their daily practice have a greater ability to solve problems and are more valued for that. How to get there? With debates!
Major controversies in Radiology will be discussed in the Point and Counterpoint Arena at the 49th edition of the Brazilian Congress of Radiology and Diagnostic Imaging (CBR 20). Discussions not to take the winners to the podium. Everyone wins in this move – debaters and audience. Based on dialogue and healthy discussion, the Arena aims to foster critical thinking and strengthen an environment with psychological safety, in which the fear of expressing opposing opinions does not prevent debate. In reality, fear ceases to exist – or, at least, to predominate. Thus, people feel more comfortable sharing ideas and innovating.
Therefore, in each panel, two professionals with different points of view will discuss their experiences, present their findings, their points of view and their perspectives.
There will be several meetings on Saturday and Sunday (October 10th and 11th) in the afternoon, with a moderator and time of 20 minutes for each debater to present his vision – point x counterpoint. In the remaining time, the participants face each other, question themselves and answer questions from the public, who will participate through a chat.
The idea is really to create provocations and heated conversations – it will be the first time that the Congress bets on the sum of these formats: arenas, traditional classes and debates. And not without a purpose: it is through debate, questioning based on reason and evidence, active listening, that science evolves. This is how we develop new learnings. And when science evolves, we also evolve as human beings!
We don't know what we don't know. By recognizing this, we understand that the will to understand and pluralize our knowledge is what makes them grow. So come join, question and learn even more with us! Participate in CBR 20 events!