Humility in medicine and our academic training environments

I sometimes wonder if we spend too much time talking about professionalism.

It is not that I don’t think we should promote professionalism. Of course we should. But many discussions of professionalism descend into overly academic and scholarly treatises that end up obscuring rather than clarifying the values such discussions hope to promote. It may be a mistake to overly intellectualize core values. I sometimes wonder if we would be better off focusing on core values and thinking about how to promote and reward those values.

Humility is one of those core values, and a wonderful essay by Dr. Jack Coulehan in the Annals of Internal Medicine wonderfully discusses the virtue of humility and its importance in medicine. This brief 2 page essay can be read in 10 minutes, and it will be 10 minutes well spent.

Coulehan has a three part definition of humility: (1) unflinching self-awareness; (2) empathic openness to others; (3) a keen appreciation of, and gratitude for, the privilege of caring for others. Coulehan contrasts humility with arrogance. In many ways humility is the opposite of arrogance.

Medicine would be well served if we had more humility and less arrogance. This is especially true in academic medicine. Coulehan notes that while medical education once promoted collegiality and shared values, it now promotes egoism and entitlement.

Too often, academic medicine encourages and rewards self-promotion and egoism. Our students notice and learn from this hidden curriculum and it clearly must lead to behaviors that are not good for patients.

As Coulehan notes, humility is not inconsistent with pride in accomplishments and achievements. But, when we have too much egoism and too little humility in our training environments, it promotes a cultural in which leaders and teachers start to see themselves as the center of the universe, rather than their students, colleagues and patients.

Good, humble leaders believe they are there for the benefit of those they lead. Arrogant leaders believe their trainees and subordinates exist for their benefit. I suspect these behaviors are contagious and a key determinant of whether one will develop into a humble or arrogant leader is which of these of attributes dominated the environment in which you trained.

Coulehan’s call for humility presents a central challenge for medicine and our academic training environments. More humility and less arrogance will do much to improve how we care for our patients, teach our students, and conduct our research.

Ken Covinsky is Professor of Medicine, University of California, San Francisco who blogs at GeriPal.

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  • Anonymous

    >>Our students notice and learn from this hidden curriculum and it clearly must lead to behaviors that are not good for patients.>>

    Absolutely. Anonymous Doc (http://anondoc.blogspot.com/) just discussed an excellent example of the “hidden curriculum” on his blog (“I yelled at a med student”). The fact is, students, just like children, watch and learn from their elders.

  • imdoc

    A well written piece on an important subject

  • http://www.medicineforchange.com/ Emily Lu

    I so, so agree with this. As I’ve written before on my blog (http://www.medicineforchange.com/physician-social-contract/), my classmates and I have in the early weeks of medical school greatly resisted talks on medical professionalism because it seemed that such talks — though they had the well-meaning aim of motivating us regarding our role in serving the community — also greatly put forward an idea of medicine and doctors as an “exceptional” profession.

    There may be reasons that medicine is exceptional, and indeed, I would be disingenuous to not say that the people that I have met in medicine are quite exceptional. But conflating that with our professional role, as you rightly point out, begins the development of a professional egoism which as a whole is detrimental for the profession and the young doctor who still has a long road ahead of them.

    In short, thank you for writing this piece!

  • Mike

    I think that this is an issue that needs to be addressed by many other professions as well.

  • http://myheartsisters.org Carolyn Thomas

    Dr. Covinsky, thank you for this. You teach medical students, so you have a unique opportunity to start changing the arrogant mindset of your young wannabe-docs before they are let loose on the public. But you may also have to somehow change the mindset of patients. Most patients want and expect their doctors to be unequivocal in their all-knowing expert knowledge of All Things Medical. “Here’s my symptom – what is it, Doctor?” We sometimes may actually equate diagnostic skill, for example, with the type of arrogance that comes with mastery over a given body of knowledge. Dr. Jerome Groopman hits this nail on the head in his book ‘How Doctors Think’, in which he cites the “18-Second Rule” – that’s how long the doctor will sit quietly before interrupting you with his immediate stab at diagnosing.

    I suggest we substitute the word ‘curious’ for ‘humble’, which implies an open willingness to both learn and ‘be present’ with others. And I agree with Mike – many other professions share this issue, and it may not be easily fixable. I’ve worked in public relations for 37+ years, and I can tell you that nobody hires a PR firm that’s famous for being humble! We like to hire experts. Knowledgeable, informed, skilled, highly experienced experts. These people are, alas, rarely humble.

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