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Having read the Open Letter to Dr. J Douglas Bremner of Emory University published on September 12, 2009 by Dr. David Gorski in Science-Based Medicine Blog in defense of Dr. Peter Lipson’s criticism of Dr Bremner I was immediately brought back to three articles all published in the 1999 medical literature.
One was by Dr Elliot Fisher from Dartmouth who was among the very first to dare to ask the basic question about “more possibly being worse” in US bio-medicine in JAMA. The second and third articles were from Dr Larry Dossey who then edited The Journal of Alternative and Complementary Medicine who wrote eloquently about intolerance among bio-medical scientists toward even considering Alternative Medicine. (see references below)
I would ask Drs Gorski and Lipson if an iconoclast like Dr Bremner might be serving a valuable role as gadfly to an entrenched failing status quo in bio-medicine who have made the mistake of deifying science? I would posit that the very essence of science is always and incessantly asking the question- “is it possible that I may be wrong?”. And I strongly support the return of narrative- the patient’s individual story- to the practice of medicine. The incomparable Sir William Osler, one of my heros in medicine, knew that well.
I believe that of all the determinants of successful US bio-medicine medicine going forward that a strong dose of humility is in very tall order.
To make progress our egos must die first- a basic psychiatric principle. It is much better and much more important to be tolerant and kind than to be right.
I support Dr Doug Bremner’s role as a colorful and passionate iconoclast. We need more like him.
Dr.Rick Lippin
Southampton,Pa
http://medicalcrises.blogspot.com
Ref-
-Fisher ES, Welch HG. Avoiding the unintended consequences
of growth in medical care: how might more be worse? JAMA 1999;
281:446-53.11.
— Dossey, Larry‘You people’: intolerance and alternative medicine. 1999;5(2):12-
17,109-112
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Thanks for writing that Dr. Lippin. I really liked your line “It is much better and more important to be tolerant and kind than to be right.” Unfortunately the “war” that is being waged is not just about ego and the inability to allow the ego to “die”. The war that is being waged is about money. Truth in doing and reporting research threatens big Pharma and threatens the funding of those who live off the blood money that Pharma pays. Until we can as a society disconnect the research being done from the drug company who stands to financially gain or lose based on the results, I just don’t see how truth will come out. We are in an awful situation as present. Pharma has tentacles everywhere. They are an evil weed.
Therapy Patient- Thanks.I’ve been thinking about the lust for power verses the lust for $ most of my life.
At any rate I am, as Doug knows, a harsh critic of Big PhRMA. I and a few others, like journalist Melody Petersen, have called for some of their CEO’s to be convicted of crimes warranting jail sentences.
Fines and lawsuits just don’t seem to be enough.
Rick Lippin
“It is much better and much more important to be tolerant and kind than to be right.”
This was meant as a joke, right?
“This was meant as a joke, right?”
No kidding. I prefer to see a doctor who places accuracy over warm fuzzys. I’m mature enough to not take it personal if my doctor isn’t always kind. Sheesh.
I’ll always take a doctor who says “I don’t know” over a pompous know it all “MDeity”
Knowledge is the easy part-True compassion is rare.
And what if the doctor does know?
Better to be both knowledgeable and kind/tolerant. Both the alternatives are bad. The road to hell is paved with good intentions (kind, but not knowledgeable). Not many patients listen to physicians they perceive as arrogant (knowledgeable but not kind). It isn’t as if one precludes the other.
Regarding:
“It is much better and more important to be tolerant and kind than to be right.”
This is something that I strive for in my own life. I’d much rather deal with people who are able to “check their ego at the door” and I try do the same myself.
Jessica and Tom, a person who insists they are absolutely right, isn’t any more right than one who is willing to listen to new information and be open to other ideas. A person needing to be “right” all the time may defend falsehoods. Needing to be right in medicine can turn into snap judgments on insufficient evidence and unwillingness to change to a better way of doing something. It can be an entire position that a person takes relative to other people so can lead to less listening, and less acknowledgment that anyone else could possibly have an insight. I know I’d much rather be tolerant and kind any day than to always be right.
“It is much better and more important to be tolerant and kind than to be right.”
Uncertainty lies at the heart of all clinical medicine. Often the ‘right’ treatment today is seen as dangerous/harmful in the not too distant future. A doctor needs to always keep in mind that ‘best practise’ is not the same as being ‘right’, and to constantly question the existing authodoxies. How else are we to make progress.
When looking after patients it is always important to remain openminded (tolerant) rather than clinging to ones one grandiose sense of rightness. I have lost track of the number of patients I have seen with debilitating side effects from medication, where their doctor insisted they were ‘right’ about what was the best medication, or insisted “that medication doesn’t cause that side effect”. A good doctor needs to check thier ego at the door, and embrace the uncertainty of clinical medicine. This does not mean that one should not ever be striving to keep as up to date as possible with the current evidence, and practise guidelines, but rather to hold everything in perspective, and keep the individual in front of you foremost in your mind (being tolerant and kind).
[...] Following my response Gorski wrote his own response about why he was getting a flu shot with a response by Rick Lippin MD on my behalf, which he also posted on his own blog, basically saying stop acting like such a, well, [...]