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Can Ignorance Be Bliss?

      Back in the 1980s, when Studio 54 was in its heyday, I taught high school science in New York City for a few years. Having graduated from a large public high school myself in a suburb of Cleveland, living in Manhattan in the early ’80s was a culture shock for me: exhilarating and wild but also a little scary. I was amazed at how many people were crowded into the city. The sidewalks were filled with drug users, sex workers, and mentally ill indviduals — many of whom seemed very angry and sometimes threw projectiles at others for no apparent reason. As a pedestrian and subway rider, I was uncomfortable with people crammed so close every day and felt vaguely, or sometimes not so vaguely, threatened.
      These experiences led me to say ill-advised things to my students on a frequent basis, like “I cannot imagine what kind of parents would choose to bring up their kids in this city.” To which the typical response was, “Oh, I suppose you will raise your kids on a farm, where they will grow up naïve and clueless and have no idea what the real world is like, so they will be completely unprepared for real life.” To which I would generally reply, “What makes you think this cesspool of a city constitutes the real world?” You get the picture.
      Yes, I had this conversation with tenth-graders, and yes, I actually enjoyed my years in the city although I was happy to get back to Ohio, specifically cow-town Columbus, for medical school after a few years of teaching. And no, it turns out that I never did raise kids on a farm (or elsewhere), but I did move to San Diego, where I have lived since residency.
      But let’s get down to the central question of this column: Is it better to be blissfully ignorant or painfully aware? The answer is different for different people and for different subjects. My attitude as a high school teacher was that it would be better to raise children in a place where they would not be subjected to dangerous and inappropriate adult behavior, at least at a young age. But I also clearly had a drive to experience “real life” in different places as I came into adulthood. That desire stemmed from a deep belief that knowledge is important, facts are important, science is important, and my ability to make informed decisions in life is only as good as the information I have to base them on.
      This deep belief has stayed with me. Throughout most of my later adult life, I made it a priority to stay abreast of current events, follow new developments in medicine and science, and to be a knowledgeable person. I’ve learned a great deal about clinical geriatric medicine and our post-acute and long-term care settings and all they entail, including the regulatory and liability arenas. I am sought out as an expert on these topics because I know them well.
      I have also historically made an effort to stay focused on organized medicine for the betterment of the patients we serve, as a member and delegate of AMDA – The Society for Post-Acute and Long-Term Care Medicine as well as the American Medical Association (AMA) and California Medical Association (CMA). Along with many like-minded colleagues, we have tried to make meaningful changes to policy and regulations over the years, in part by communicating with legislators and regulators. We recently lobbied for the passing of legislation in California that will require all nursing home medical directors to be certified. And at June’s AMA House of Delegates, the resolution sponsored by the Society requesting that the Centers for Medicare & Medicaid Services create and maintain a listing of all medical directors became AMA policy.
      Over the years I’ve also grown accustomed to watching the news a lot, although these days what passes as “news” on most networks is pretty biased. Well into the early part of the pandemic, I would leave cable news stations on for hours every day. I realized, after considerable self-reflection and talking to trusted family and friends, that the information I was absorbing — even when recounted objectively — was just making me feel miserable, hopeless, and powerless. There were so many things going on all over that I had no direct ability to change.
      I’ve always been a champ at sleeping, but I started to have occasional trouble falling and staying asleep because the sad state of our country and the world were bothering me. And worse, I was finding it increasingly difficult, given some of the responses to the pandemic, the anti-science movement, and domestic and international politics in general, to believe that most people are generally good. I still hope that’s true, but it’s hard to believe in my gut these days.
      So my household made a bold move last year: we just decided to stop turning on the news. Now when we are indoors we put on a variety of awful reality shows featuring ill-behaved millennials, cooking shows, tennis tournaments, home renovation programs — anything except the news. And, perhaps not surprisingly, I find myself feeling a lot less hopeless and blue.
      I do see headlines on my smartphone, and occasionally I read more about things I care about and might be able to act on. Obviously I can’t avoid some level of awareness when I use the internet. But I don’t need to see photos of children shot dead in a school or in the Ukraine for hours on end. I don’t want more detail about how the Supreme Court is chipping away at the rights of Americans or other hypocritical politicians are spouting hateful lies. I am already sufficiently aware of the predictions that Miami will be underwater in 15 years (and really — can San Diego be far behind?).
      It’s been positively liberating to step away from the negativity.
      How does this relate to our care setting, you might ask? Well, some of our patients who are facing serious or even terminal illness really want to know what’s going on with them — the laboratory values, the imaging results, the physical findings, and the prognosis; others most decidedly do not want to know such details. I read a study many years ago (that I’ve been unable to find, sadly) suggesting that patients who trust the process and do not request a lot of information about their condition actually do better clinically than those who want to micromanage.
      So, in my practice, before I get into a lot of specifics about my patients’ conditions, I ask permission and always ask what they understand. People have a right to seek as much or as little information as they are comfortable seeking, and we should always respect that, even if it is not what we’d want ourselves.
      I am not giving advice at all about your own news-watching proclivities, gentle readers. This is just anecdotal evidence, a study of my little family with an n of 2 (not counting the dogs). Cutting off the information flow was difficult initially, but I truly feel more serene now. We do not miss the hours of cable news a day, and I am able to keep up with the things I feel I might be able to exert an influence on without being barraged by all the stuff I clearly can’t.
      We are not quite living on a farm, but we’ve spent a lot of time in the mountains lately. The magic of nature — along with the absence of constant toxic negativity — have given us a great deal to be grateful for. At least where it comes to the news, my newfound ignorance has indeed been blissful.
      Dr. Steinberg was the 2021-2022 president of AMDA – The Society for Post-Acute and Long-Term Care Medicine and is editor emeritus of Caring for the Ages.