Physician, know thy limits

I enjoyed the first article by Donald Redelmeier and colleagues on problems for clinical judgement.1 I was particularly interested to note that overconfidence ranks high as a source of clinical errors (3 of the 9 causes of fallibility relate to overconfidence, if one considers unquestioning self-approval and unawareness of limits of judgement as aspects of overconfidence). I suspect that a key reason for this lies not in physicians' lack of knowledge of cognitive psychology but in the fact that hubris is actively encouraged and rewarded during medical training.

As someone who went to medical school after several other careers, I was often appalled by the way arrogance and overconfidence were encouraged during medical training. Indeed, during clinical training I was frequently criticized for expressing uncertainty and humility to patients or teachers. It struck me as ironic that awareness of the limits of one's knowledge or data is encouraged in graduate school (I have a PhD in biology), where the degree of uncertainty is far less than in clinical practice. Perhaps the level of certainty in professional discourse is inversely proportional to a profession's scientific rigour?

Will Rogers is reputed to have said, “The problem is not what you don't know but what you know that ain't so.” I believe that medical educators should take this to heart and reform their approach accordingly.