Thread by @medicalaxioms

When I was a med student and resident, I was taught the Culture of Criticism.

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When we noticed practices that differed from our own (adolescent, inexperienced), we were taught to criticize. Ridicule.

This offered a moment of superiority for the student or resident who otherwise spent a lot of time facing inferiority, ignorance, and error.

It’s a bad habit though. One certainly worth breaking.

First, it taught us to believe that differences in style were somehow negligent.

Second, it taught us to engage in an adversarial relationship with our medical colleagues. One that manifest as suspicion, criticism, and disdain.

Starting about PGY-10, I completely changed my approach to the medical decisions made by other doctors.

I start with a an assumption of reasonableness. I seek to defend past decisions and give the benefit of the doubt.

I respect the challenges presented by the circumstances in which the decision was made: a 10 minute office visit.

I respect the fact that the patient’s presentation and condition was likely different 6 months ago. Or an hour ago.

My job is easier because time has passed and things are now more clear.

It also allows me to find the particular element of the care I might disagree with. Instead of “stupid doctor at Outsdie Hospital is stupid,” it becomes “I might have gotten an MRI for this diabetic foot infection after the first course of PO antibiotics didn’t work.”

Most importantly, it has changed my relationship with the body of the medical community.

The question is no longer, “Is this what I would have done?”

Instead it becomes, “Was this decision one of a number of reasonable decisions in this circumstance?”

It’s an attitude of charity, and also an attitude of humility. It allows me to consider more options than the first judgment that pops into my mind. It allows me to separate stylistic differences from evidenced-based science.

It also reminds me that there is no one right approach for all patients. Each diagnostic or treatment plan needs some tailoring to the specific patient for whom it is designed.

Why wasn’t this homeless 22 year old on an insulin pump? Maybe because he is 22 and homeless. I’d have to get to know him and his situation better before I decided if that was reasonable.

Reasonableness respects that there is almost always a range of options that could be considered for any particular patient and situation.

I’ve learned a lot more medicine and avoided becoming increasingly dogmatic in my practice by seeking to understand and even defend the practice of other doctors instead of starting with criticism.

It has taught me that there is a lot of good, reasonable medicine being practiced all over. It doesn’t always work because a) nature is complicated and b) everybody winds up dead from something eventually.

The rule seems to be there are a lot of good intentioned doctors out there making hard decisions with limited information. Exceptions in the form of sinister practitioners making negligent decisions are rare.

If you feel the need to feel superior and ridicule the decisions made by someone, read your own charts from a few years ago. You’ll see you didn’t have the whole picture. You made quick decisions based on limited information.

After you read the discharge summary, practice the principle of charity I have described here.

Don’t ask, “Was I right?” on day one.

Instead ask, “Was my decision reasonable based on the information and situation I was faced with at the time I saw the patient?”