A riot of divergent thinking
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2011)

How many uses can you think of for a paper clip? Most people might come up with 10 to 15. People who are good at divergent thinking, a method championed by educationalist Ken Robinson, would come up with around 200. Divergent thinking is the ability to interpret a question in many different ways and the ability to see many different answers to a question. Divergent thinking is similar to Edward de Bono's concept of lateral thinking, an essential skill you might imagine for any clinician (http://www.youtube.com/watch?v=zDZFcDGpL4U).

Unfortunately, our capacity for divergent thinking deteriorates with age. A longitudinal study of kindergarten children measured 98% of them at genius level in divergent thinking. Five years later, when they were aged 8 to 10 years, those at genius level had dropped to 50%. After another five years, the number of divergent thinking geniuses had fallen further still. Robinson argues that the main intervention that these children have had is education, a conveyor-belt education that tells them that there is one answer at the back of the book but don't look and don't copy.

When I first heard about Robinson's take on divergent thinking, courtesy of the headmistress of my daughter's school, the deterioration process awoke memories of medical school, where a barrage of education beats the living daylights out of the thinking capacity of many of the nation's brightest students. The paternalistic model of clinical practice has only binary constructs of diagnosis and treatment, only one answer at the back of the clinical textbook.

Medical schools and clinical practice have evolved to embrace group and problem-based learning, to appreciate the uncertainties in patient care. Medical educationalists, trainers, and mentors continue to scratch their heads about how best to invigorate and inspire their charges. But it can feel alien to consider knowledge as a fluid concept after years of trading in educational certainties.

Are you, for example, prepared to accept a new medical ‘disorder’ that seeks to explain dysfunctional behaviour in children? Is adaptive violence disorder, a condition hypothesized by the charity Kids Company, observable in some children who have been persistently abused physically and psychologically? Is it a possible explanation for the behaviour of youths rioting and looting in this past summer of discontent? Or is it just another example of medicalisation of every aspect of human behaviour, in this case medicalising plain bad conduct (JRSM 2011;104:392–3)?

In the spirit of divergent thinking, it depends on how you interpret my questions and the many possible answers you can see. What is clear, however, is that we need more divergent thinking, not less. Worse still, the blight of convergent thinking isn't restricted to medical students and clinicians. Indeed it is running its own riot among policymakers. When we discover that private finance initiative hospital projects that have a cost price of £11bn will eventually lead to £70bn in repayments, and that an equivalent £11bn was sunk into the failed National Programme for Information Technology, you begin to wonder what might have been achieved with the divergent thinking capabilities of a kindergarten student?