I Wish Medicine Practiced Radical Honesty

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When I was filling an entry-level job in a government hospital in India right after completing my M.B., B.S, I joined the surgery department for a one-year position. I liked my colleagues, and the surgeons were considered to be the coolest of the cool. It was an easy seduction to fall into and I decided I wanted to do surgery.

Now, anyone who knows me well knows that I tend to be intellectual, but hand-eye coordination is not my strong suit. I never had any major interest in surgery up to that moment. In fact, the very thought of doing procedures would push me into a state of fight-or-flight. Quite the opposite of the Zen-like focus of an excellent surgeon.

One event has stayed with me until now. I was placing a Foley catheter in a male patient and I mistakenly inflated the retention balloon in the urethra and the patient sustained a severe urethral injury that required his hospitalization for two more weeks.

I continued to do an Internal Medicine residency in the mid-west in the United States and did well as a resident. I was well-respected for my work and was offered a chief residency. But such procedures still made me nervous. I avoided them when I could and no adverse events took place on patients.

Looking back on my days in internship and early residency, I wish I had the necessary self-awareness to realistically know my own strengths and weaknesses. I wish I could have stepped back from myself and seen the intense anxiety I had about doing something procedurally that would have hurt a patient. I wish I had the courage to bring up these fears with an attending physician or the program director.

This is just one example of the many blind spots a physician can fall into and continue to be unaware of. Over the years, given the personal work I have done, I have discovered many of my blind spots and know there are many more to discover. While there are some opportunities for feedback up until residency, the opportunities stop there. Furthermore, the feedback obtained during our clinical days, tend to be limited and lacking in depth. The most obvious way to improve the breadth and depth of feedback is to take up the practice of non-judgmental self-awareness.

To reach a level of mental maturity where one can unflinchingly look at one's own strengths and weaknesses requires a level of confidence that can be fostered by unconditional acceptance. Medical institutions can foster this by introducing and discussing the concept of unconditional acceptance. It implies that all feedback is seen as constructive and never meant to belittle the individual on the receiving end. And then there is no shame in admitting one’s weaknesses.

On the contrary, the only way to overcome a weakness is to realize it, accept it, and correct it. Failure then becomes a stepping-stone instead of a judgment. The correction may include improving one's skills or simply having someone else do particular tasks. And the principle of constant and never-ending improvement becomes one of the cornerstones of every practitioner’s ethics. In that environment, people thrive and the systems that they function in reach new levels of excellence.

Ray Dalio in his much-acclaimed book Principles discusses how his hedge fund Bridgewater has achieved the pinnacles of success using the principles of radical honesty and radical transparency. These are principles that are very much needed in the medical world. I wish there was an opportunity at different phases in my medical education and career to look at my strengths and weaknesses, as perceived by me and also as seen by my colleagues. I wish there was a dedicated practice of radical truth in medicine where we could see ourselves as objectively as possible and use our strengths and get help and support in our weak areas.

There is a strong need for a comprehensive platform for the introduction of these principles in our medical curriculum. It has to start at the stage of career counseling — the importance of following one's passion and strengths is critical to guide young students and practitioners. In a stage of one's life where coolness and possibly money can guide our career choices, loving and steady mentors could guide us to make better choices. And once in medical school, a curriculum can be put into place that will help individuals realize the wonderful power of honest self-reflection combined with feedback from educators and peers.

Simply put a system can be put into place of radical honesty and self-reflection. This kind of culture in our healthcare systems would dramatically improve patient outcomes while allowing the maturing of individuals into confident, calm, and grounded doctors who settle for nothing less than excellence.

Dr. Thomas Alexander is an internist who is passionate about giving good care and impacting health in the best possible way, especially prevention.

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