The 'Knitting Lady' Is a Surgeon and She's Paying Attention

Unlike Phones, Handiwork Does Not Distract

Nick Mulcahy

August 12, 2019

Last month, Rhea Liang, MBChB, attended a professional conference in her homeland of Australia. She brought along her current crocheting project, a lap quilt that will be a wedding gift for her cousin.

Liang, an associate professor of surgery specializing in breast cancer at Gold Coast Hospital and Health Service in Robina, does "wool craft" during lectures to help her listen to and recall information.

Toward the end of one presentation, Liang and her crochet quilt were thrust into the meeting spotlight — a moment she (@LiangRhea) described on Twitter.

The tweet set off hundreds of retweets and responses, mostly from healthcare professionals.

Dozens of nurses, physicians, occupational therapists, medical students, midwives, and others tweeted that they can't pay good attention — unless they knit, crochet, knot tie, macrame, sew, needlepoint, or doodle. Repeatedly, people said their mind wanders without manual activity.

Kathleen Wild, MD, general practice lecturer, University of Newcastle, New South Wales, Australia, spoke for many (@KathlWild): "Knitting helps me pay attention to what's going on, if I wasn't knitting I'd be daydreaming!"

Another Tweet was also representative of the responses: "I'm able to better pay attention to you because I'm knitting, not in spite of it."

Kerry Wilkins, MD, a psychiatrist in private practice, Millbury, Massachusetts, (@KerryWilkinsMD) provided neurological explanations about what others described anecdotally.

Wilkins' "illuminating" comments, said Liang, "back up what many crocheters/knitters have figured out empirically for hundreds of years." To wit: "Knitting grannies don't miss a thing," she summarized.

Before the tweetstorm, Liang believed her crocheting-while-listening-and-learning at scientific presentations was an "individual quirk." Now she sees it as evidence of "neurodiversity" and is grateful to have met so many similarly wired learners through her post.

Not all Twitter users were supportive.

Al Rush, former paramedic, Royal Air Force, UK (@RAF_IFA), saw Liang's crocheting as a problem. "Don't you think it might be a little disrespectful/distracting to the presenter and/or other delegates?" he replied to Liang's original tweet.

Liang countered: "Any more than everyone else tapping on phones, scribbling on paper, or typing on devices?"

Next, Rush, a retired paramedic, posted a photo of himself as a young man with three women, all kneeling by a Resusci Annie doll: "Me, teaching infant Emergency Life Support — too important for knitting."

In response, Liang pointed to sexism from the presenter at the surgical meeting.

"My original point stands — calling me out when I am paying attention, while not calling out the guy next me [who is] not paying attention — there are only ugly reasons #bias," she posted.

Related Science

Much of the understanding of how repetitive physical activities are connected to attention and cognition comes from brain imaging studies of people with attention deficit hyperactivity disorder and autism spectrum disorder, the Massachusetts psychiatrist Wilkins told Medscape Medical News.

However, the general population also has its own "regulation strategies" to enhance focus when there is "motor overflow" in the brain, which may occur when we confront big cognitive challenges (like listening to a scientific lecture), she said.

Think of the work colleague, Wilkins gave as an example, "whose leg is always moving up and down under the table during meetings, or someone who taps his pen when he's focusing intently."

Knitters, crocheters, and other handiworkers have not been studied in this regard. (A PubMed search turned up nothing.)

However, doodlers have been.

In a first-of-its-kind study, adults randomized to doodling recalled 29% more information on a surprise memory test than controls after listening to a mock telephone call (Appl Cogn Psychol. 2009;24:100-106). "Unlike many dual task situations, doodling while working can be beneficial," wrote study author Jackie Andrade, PhD, University of Plymouth, UK.

Jan Odom Forren, PhD, RN, agrees. "I have friends who knit or crochet in meetings. I doodle while I listen. For all of us, it helps us stay focused!" tweeted Forren, professor of nursing, Lexington, University of Kentucky (@JanForren), who responded to Liang's tweet.

The Surgery–Handiwork Connection

Today's medical school students are less dexterous than in the past, which may impact new generations of surgeons, argued a group of five physicians in a New York Times article published earlier this year.

The reason? The rise in screen swiping and decline of manual hobbies such as woodworking and sewing, they speculate.

Crocheting improves manual dexterity, shouted Twitter users after breast surgeon Liang's dustup.

Lisa Dietrich, PhD, behavior researcher, Stony Brook University, New York, humorously stated the obvious (@lldiedrich): "She [Liang] has nimble fingers. Just like...wait for it...a surgeon."

In vascular surgery, the relationship between crochet and surgery could not get any more direct: there is a "crochet hook method of stab avulsion phlebectomy for varicose veins," as described in an article published in the American Journal of Surgery (1996;172:278-280).

Manual Hobbies Are a Learning Aide — But Not a Fully Accepted One

As responses to Liang's tweet indicate, handiwork is a learning aide for some healthcare professionals.

Patricia Furey, MD, vascular surgeon, Catholic Medical Center, Manchester, New Hampshire (@drpfureymd), tweeted: "I spent the first 2 years of medical school knitting during lectures at Dartmouth 20 years ago."

But other people indicated that the practice is not routinely accepted.

Kayte Kett, MD, a pediatrician in the UK (@kayte_mccann) also knitted during medical school lectures: "But, I used to do it under the table in old fashion lecture theatres in case I got told off. It kept me awake and I was knitting hats for the delivery suite."

The fear of being caught was also expressed by Elva Robinson, PhD, senior lecturer, biology, University of York, UK (@Elva_Robinson). "Recently did some sewing during a course and it genuinely increased my concentration — but I was nervous I would be called out on it," she tweeted.

Liana Clark, MD, said knitting is not allowed in the pharmaceutical industry. She is senior medical director, Global Medical Strategy, Sanofi Pasteur, Swiftwater , Pennsylvania.

"Never had trouble knitting in peds/adolescent medicine. But pharma? You would think I was doing a pole dance! There's no knitting in pharma! #knittingislife," wrote Clark (@teendoc), formerly at the Children's Hospital of Philadelphia. "It's just the culture. Knitting seems unserious," she said.

Manual crafts are esteemed and tribal at some scientific conferences.

Sunae Reilly, midwife, Gold Coast, New Zealand (@saltwater_sunae), tweeted: "As a midwife, it's EXPECTED we knit or crochet at conferences."

Sarah Bodell, occupational therapist, Salford University, Manchester, UK (@OTSalfordUni), told Liang: "You need to join at the @theRCOT annual conference. We have zones for knitting, creating, sewing and more."

It's a Female Thing

Rhea Liang, MBChB

Manual crafting or handiwork is perceived as a female thing, Liang said: "I think what the presenter conveyed was — 'I am uncomfortable that one of the audience is doing a generally female activity.'"

Practicing a golf swing would have been more acceptable, she quipped.

Gender-limited crafts are a loss for males, said Robert Hill, MD, chief executive officer, Harmonigenic, a cancer diagnostics and outcomes company in Rochester, New York (@harmonigenic).

"My son began knitting in 4th grade & started knitting on the way to school riding the bus, but wasn't able to continue with all the teasing," he responded to Liang. "More people should normalize it."

Manual crafts are not gender exclusive, observed Charles Jenkinson, MBBS, cardiothoracic surgeon, Fiona Stanley Hospital, Murdoch, Australia (@charlesj_au).

"My grandmother taught me to sew and knit in primary school...I still fix all of my children's toys — these days with 3-0 prolene or silk," he wrote, in response to Liang.

Also, Michael DeBakey, MD, artificial heart pioneer, "credited his surgical success to his Mom teaching him how to sew and knit," tweeted Sara Jiang, MD, associate professor, pathology, Duke University, Durham, North Carolina (@Sara_Jiang).

Final Thought

Among the Twitter respondents to Liang was Jelte (@JltJ), a general practitioner in Arinagour, on the island of Coll in Scotland, UK, who is living with primary mediastinal B-cell lymphoma and is recently 1 year with no evidence of disease.

The physician, who does not list her name in her profile, had some advice for Liang — via Batman — on how to handle future troublesome meeting presenters.


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