DB'S MEDICAL RANTS

Internal medicine, American health care, and especially medical education

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Tips for IM Attendings – Chapter 2 – Humility

Humility is to make a right estimate of oneself.”

– Charles Haddon Spurgeon

Don’t think too highly of yourself. But also don’t think too lowly of yourself. That’s false humility.”

– Tony Bennett (UVa Basketball Coach)

The best clinicians and the best educators exhibit humility.  As a student and resident one attending physician repeatedly told us the importance of humility.  Dr. Orhan Muren, a 5 foot tall Turkish pulmonologist, repeatedly told us that “in medicine never get cocky”.  He was telling us to avoid hubris.  He told us to consistently ask ourselves if we had the correct diagnosis, testing plan or treatment.  He stimulated us to second guess ourselves and to engage others if we needed our own second opinion.

As a 2nd year resident, I once had an intern who made some decisions that exceeded his level of competence and experience.  I remember telling him that he had to understand the limits of his expertise.

I often tell students and residents that lack of knowledge is acceptable, but not understanding your lack of knowledge is dangerous.  These words fit the two quotes above.  We demonstrate humility when we understand both what we know and what we do not know.  When we request help for those issues that we do not understand,  we often help our patients.  When we believe that we know more than we do, we may harm our patients.

As educators we should embrace humility.  We should remain humble about our teaching skills as well as our clinical skills.  Try this educational experiment.  Teach something brilliantly.  Explain a topic that you know extremely well.  Ask the learners if they understand.  Then ask them questions relevant to that topic 1 or 2 weeks later.  You will likely learn that the art of inducing learning is much more difficult than the ability to explain a topic clearly.  Once you understand how difficult learning really is, then you have a much better understanding of educational humility.

We can teach our learners humility through our actions as well as our words.  Our learners need role models who do not pretend to know everything.  Our learners need us to accurately represent our strengths and our weaknesses.  When the learners see true humility, then most will mimic that humility.  We do have the responsibility to not criticize learners who do not know something and admit it.  We should let them know that we know have an opportunity to improve their understanding.  We should avoid penalizing humility, rather we should verbally reward our learners who are working hard to improve, yet recognizing their deficiencies.

We should criticize hubris since developing hubris happens too often in medicine.  Hubris is our enemy.  We all have the opportunity to develop hubris, as the health care environment often gives us too many opportunities to develop that trait.  As educators we should fight that development and substitute humility in all our learners.

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