So, what exactly is a blank slate?

We often say, “Let’s start with a blank slate” when we mean starting from zero—with no assumptions, no preconceived ideas, and no previous information influencing what comes next.

It sounds reasonable. The problem is that, when dealing with people, a true blank slate rarely exists.

When discussing findings, treatment options, or even insurance benefits with patients, it is almost impossible to start from zero. By the time people come to us, they have already accumulated information from previous doctors, friends, family members, social media, the internet, insurance companies, and, most importantly, their own experiences.

All of that information is already written on their slate.

Imagine a scientist who has spent several nights working on a complicated problem. His blackboard is covered with calculations, notes, theories, and conclusions. Then someone walks into the room and tells him that his calculations are wrong and he needs to erase the board and start over.

What do you think his first reaction will be?

Most likely, he will defend his work.

And understandably so. He has invested time and effort into reaching those conclusions. Before erasing anything, he will want to know why it is wrong.

People are not very different.

When confronted with new information, we don’t evaluate it in isolation. We look at it through the lens of what we already know—or believe we know. Psychologists describe part of this tendency as confirmation bias: we naturally give more weight to information that supports our existing beliefs and are more skeptical of information that contradicts them.

This creates an important challenge when communicating with patients.

If we begin a conversation by immediately telling someone that what they believe is wrong, we may unintentionally force them to defend the very belief we are trying to change.

So, no, we cannot simply ask people to start with a blank slate.

Instead, we should first understand what is already written on it.

We can acknowledge the information they have gathered, recognize the parts that make sense, and understand how they arrived at their conclusions. Only then can we gradually introduce new information—one piece at a time—while checking that each new point makes sense within the larger picture.

The objective should not be to erase someone else’s blackboard and replace it with our own.

It should be to give them better tools and better information so they can reconsider what is already there.

Ultimately, the most powerful conclusions are often not the ones we give people.

They are the ones they reach themselves.

And when new information is strong enough, people will begin erasing the pieces that no longer make sense on their own.

Maybe the goal was never to create a blank slate.

Maybe the goal is to help people rewrite it.