Posted by: notdeaddinosaur | December 23, 2015

Balancing Between Hubris and Despair

Dr. Robert Centor has an important post about hubris. It’s not a long post, if you want to click through and quickly read it. It’s about the danger of overweening pride and overconfidence that can come from blindly believing the praise that is often heaped upon us by those in our care. Essentially Dr. Bob is saying that we must avoid believing all the wonderful things our patients say to us.

One the one hand, I agree completely. Pride indeed goeth before a fall, and in our line of work, the pain of our falls is literally felt by others. The line between the confidence we need in order to do what we have to do, and over-confidence that leads to potentially fatal errors of judgment is painfully narrow. All too easy to slip over without even realizing; the only safeguard is constant vigilance.

There’s a phenomenon known as the Imposter Syndrome that affects basically everyone early in medical training (and many other endeavors as well.) It occurs when someone tells you how smart you are, or what a good doctor you are, and you think, “Geez, I really have them fooled. They have no idea that I haven’t a clue about what I’m doing.” Although this feeling gradually (oh so gradually) abates over years (and decades) in practice, I’ve always felt that hanging onto at least a shred of it functions as a bit of a “hubris safety net.” Being able to honestly say to oneself, “It’s nice to hear that, but I’m really not as great as they think,” is, I think, a good thing.

On the other hand…Yes, there is another hand here:

I’ve been in solo practice for a long time now. Days can go by without talking to another physician; weeks without seeing one. No residency director is evaluating me every six months, yet I’m pretty sure I’m doing a good job. Once every few months or so, I get the equivalent of positive feedback from a colleague. Usually a patient returns after seeing Dr. X telling me how Dr X regaled her about how great I am. Sometimes another doctor will also say it to my face, though frankly I still wonder a little that they’re just buttering up their referral sources.

So how do I keep up my morale, my self-confidence, my emotional well-being? Dr. Bob and others in teaching situations have the immediate and ongoing positive responses from their learners. In the inpatient setting there are always plenty of other physicians as well. Hubris can indeed be seductive with so much positive feedback around, but how can one maintain one’s emotional well-being from patients alone, without succumbing to the dreaded scourge of hubris?

I believe I have the answer.

I got the following letter earlier this month, reprinted here in its entirety with permission from the author:

When I was pregnant with [my son] you asked me if you would gt to care for him as a patient. I was slightly offended. The doctor that kept me calm through an ovarian mass in my 20s, a depressed suicidal husband in my 30s, always answered the office phone with a same day appointment, always answered my frantic phone calls or responded to my messages asking for help, saw my daughter through every illness and age related medical milestone, wrote me a note to stay home from work when I was too mentally stressed to work the day after our beloved dog was put to sleep, a doctor that I trust my own life and the rest of my family’s life with, asked if she would be graced with my baby as a patient. Well I certainly didn’t want him in a giant practice with a million doctors that have no clue about our family history and that wouldn’t recognize him at the grocery store. [We often run into this family while food shopping.]

You are brilliant, funny, and obviously the best doctor ever! Thank you for being awesome and for choosing your calling of medicine. We appreciate it! May the universe bless you with abundance, always. Love…

Obviously reading this feels wonderful, and it’s not hard to understand slipping into hubris while doing so.

The key is to appreciate and accept the expressed emotions of gratitude and affection instead of taking it as an objective assessment of my superior knowledge or abilities. It gives me warm fuzzies whenever I think about it, and that’s good enough.



  1. The Bly person that really knows your incompetence is you yourself

  2. Here’s a possible extraneous comment from a long-suffering patient. I have received so many instances of care that borders on malpractice, actually is malpractice, is useless but seems to be given just for the doctor’s protection from a malpractice suit, and so on, over a long period of time, that, especially with a doctor new to me (a referral for example) when I hear something that really makes good sense or when something works particularly well, I am effusive in praise.

    A major reason why I do this, I just realized reading your post, is some possibly vain, and certainly ignorant (relative to the doctor, not the general level of patients’ knowledge) attempt to influence the doctor. My praise is usually fairly specific and my aim is to ask for “more like this” in treatment. It is usually like “Thank you so much! That is so much better than Dr ____ (or a vague reference not including the name) told/ordered/etc to/for me! I’m so glad someone finally _____ (fill in blank).”

    I don’t know if that gives the doctor a swelled head (I enjoy the smile I get as a reaction) but I thought I’d express the fact that my praise is meant to inform the physician in some manner and encourage the kind of thinking I perceive that went into it. It sometimes leads to a discussion that better informs me, also.

  3. Cal: It sounds like you’re thinking in terms of behavior modification. Reinforce good behavior (good medical practice) with praise in order to encourage the doctor to continue behaving that way. Too bad it doesn’t work that way. Good doctors appreciate the praise, but (sadly) bad doctors aren’t going to improve in its absence.

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