I was searching for a couple of papers by Harlan Krumholz today for another post and came across
this piece just published. I found it inspiring. He writes about the difficulties and challenges of standing against the status quo, even when, especially when the vested interests as they mass in opposition seem to brook or tolerate no opposition. A few choice passages (underlined by me):
"Unfortunately, our profession does not often reward those
who question dogma. In fact, there are many episodes
throughout the history of medicine and science in which truth
was resisted and dogmatic beliefs, however poorly supported
by evidence, were imposed by those in a position to do so. If
we are to accelerate innovation in medicine, eliminate waste-
ful practices, and improve the depth and effectiveness of how
we care for patients, then there must be room to question
traditional approaches and to introduce new and better ways
of prevention, diagnosis, and treatment. We are now at that
critical juncture.
When I entered medicine, I did not realize that there was
such intense pressure to conform. But we learn early on that
there is a decorum to medicine, a politeness. A hidden
curriculum teaches us not to disturb the status quo. We are
trained to defer to authority, not to question it. We depend on
powerful individuals and organizations and are taught that
success does not often come to those who ask uncomfortable
questions or suggest new ways of providing care.
I have grown to appreciate those who will stand up despite the
risks or in the face of efforts to silence them. Promoting the best
science and the best advocacy for patients and the public
sometimes entails risk. Change does not come easily to a system
and there is resistance to those who may seek to make the system
safer, more effective, and more patient-centered through new
ideas or the articulation of uncomfortable truths."
He also quotes from Victor Montori, from Mayo Clinic who writes:
"I have struggled with this issue for years. Turns out
that this is a common struggle for those who find
themselves unable to stay silent in the face of waste,
error, low integrity, or abuse.
If you find yourself with some time (not a lot), let me
recommend Letters to a Young Contrarian by Hitchens.His argument that clarity emerges from conflict is
compelling. And for conflict to emerge, ie for clarity to
emerge, someone has to take a position. The question
you ask is whether this should be you, now, and at this
stage of your career."
Read it and distribute widely.
