{"id":2484,"date":"2018-09-04T13:34:29","date_gmt":"2018-09-04T17:34:29","guid":{"rendered":"https:\/\/blogs.nejm.org\/general-medicine\/?p=2484"},"modified":"2018-09-04T13:34:29","modified_gmt":"2018-09-04T17:34:29","slug":"the-power-of-intellectual-humility","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2018\/09\/the-power-of-intellectual-humility\/","title":{"rendered":"The Power of Intellectual Humility"},"content":{"rendered":"<h2><strong>Don\u2019t ever be afraid to say, \u201cI don\u2019t know.\u201d<\/strong><\/h2>\n<div id=\"attachment_2455\" style=\"width: 135px\" class=\"wp-caption alignright\"><a href=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2018\/07\/AU000_shippe.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-2455\" class=\"size-full wp-image-2455\" src=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2018\/07\/AU000_shippe.jpg\" alt=\"Scott Hippe, MD\" width=\"125\" height=\"150\" \/><\/a><p id=\"caption-attachment-2455\" class=\"wp-caption-text\">Scott Hippe, MD, is a Chief Resident at Family Residency of Idaho in Boise.<\/p><\/div>\n<p>Those were parting words from\u00a0one of my\u00a0physician mentors in medical school. I had asked him for wisdom in making the transition to residency. \u201cIn my career, I\u2019ve seen hundreds of physicians who cannot bring themselves to say those words. They are generally the ones who get burnt out. They are the ones that shout at you when you consult them over the phone. They are the ones who leave medicine, one way or another.\u201d<\/p>\n<p>My mentor\u2019s point was to stay intellectually humble. The practical application to clinical medicine is obvious. We\u2019ve all learned about the different types of biases that lead to medical errors and diagnostic misses. As trainees, we have seen physicians who exhibit too much hubris make mistakes.<\/p>\n<p>I am reminded\u00a0of my mentor\u2019s comments now that July has arrived and a new class of interns has started their training. Their enthusiasm for residency and the pursuit of learning is a breath of fresh air. Along with the enthusiasm has come a multitude of \u201cI don\u2019t knows\u201d:<\/p>\n<blockquote>\n<ul>\n<li>\u201cI don\u2019t know where to go when we start in the hospital tomorrow.\u201d<\/li>\n<li>\u201cI don\u2019t know how the attending likes case presentations.\u201d<\/li>\n<li>\u201cI don\u2019t know my dictation number.\u201d<\/li>\n<li>\u201cCan my patient eat?\u201d<\/li>\n<li>\u201cCan I eat?\u201d<\/li>\n<li>\u201cWhat is the best flavor of enema?\u201d<\/li>\n<li>\u201cDo I need an enema?\u201d<\/li>\n<li>\u201cShe brought her service animal into the hospital, but she didn\u2019t say it was a python.\u201d<\/li>\n<li>\u201cI don\u2019t know what to do about his pain\u00ad \u2014 he told me he\u2019s allergic to everything but Dilaudid.\u201d<\/li>\n<\/ul>\n<\/blockquote>\n<p>Residency is endlessly humbling, but interacting with interns has shown me how much I have grown as a physician. I can answer all of the questions mentioned above, and even a few more.<\/p>\n<h2><strong>One thing is getting harder to say<\/strong><\/h2>\n<p><a href=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2018\/09\/Dont-know.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-2501\" src=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2018\/09\/Dont-know.png\" alt=\"&quot;I don't know&quot; post-it note\" width=\"259\" height=\"194\" \/><\/a>As my years of residency have gone by, and I have made the transition to senior resident, it has gotten harder to say \u201cI don\u2019t know.\u201d Just like my mentor predicted. Not knowing things on the wards or missing something in clinic stings my pride more now than it did when I was an intern.<\/p>\n<p>The most common feedback I give to medical students and interns is to be decisive with their plans. This was also the feedback I received on my own medical student rotations. I imagine it is feedback most learners receive. Being a competent clinician requires synthesizing large amounts of data and committing to a plan of action. But it is also possible to take \u201cdecisive\u201d too far.\u00a0A phrase has stuck with me:<\/p>\n<blockquote><p>\u201cSometimes wrong, never in doubt.\u201d<\/p><\/blockquote>\n<p>A\u00a0surgeon said this, while preparing to take a patient with abdominal pain to surgery for suspected appendicitis.\u00a0 In this particular instance, appendicitis is exactly what the patient had. It was one of those times to be decisive, and <em>rapidly<\/em> decisive. But whether\u00a0through conscious effort or subconscious tendency, we often take \u201cfake it until you make it\u201d too far. We become insecure and isolated clinicians hiding behind fa\u00e7ades of confidence. This tendency leads to worse outcomes.<\/p>\n<h2><strong>Benefits of intellectual humility<\/strong><\/h2>\n<p>Although \u201cI don\u2019t know\u201d gets harder to say, I am convinced\u00a0it is one of the most important phrases in the practice of medicine. Embracing the intellectual humility necessary to utter those words has many benefits:<\/p>\n<ol>\n<li>Encouraging curiosity:\u00a0this leads to broader differentials and more effective diagnosing<\/li>\n<li>Counterbalancing \u201cintervention bias\u201d: the tendency of clinicians to do something \u2014 anything! \u2014 when the best course of action might be to do nothing<\/li>\n<li>Effective teamwork: clinicians who admit they don\u2019t know everything are more open to the input of others and more likely to see the patient\u2019s big picture.<\/li>\n<li>Better education: A safe environment, where learners are empowered to disclose their gaps in knowledge, allows educators to address those gaps more effectively.<\/li>\n<\/ol>\n<p>For newly minted resident physicians, my advice is to embrace \u201cI don\u2019t know.\u201d You will do yourselves and your patients a great service. I will continue to say those three words as well, no matter how sharply it hurts my pride. If any of this inspires passion, positively or negatively, please leave a comment. I am looking forward to communicating with you this year through the <em>Insights<\/em> blog.<\/p>\n<p>&#8211;Scott<\/p>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/resident360.nejm.org\/\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-926\" src=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2017\/03\/genMedRes360Ad540x250.jpg\" alt=\"NEJM Resident 360\" width=\"540\" height=\"250\" \/><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Don\u2019t ever be afraid to say, \u201cI don\u2019t know.\u201d Those were parting words from\u00a0one of my\u00a0physician mentors in medical school. I had asked him for wisdom in making the transition to residency. \u201cIn my career, I\u2019ve seen hundreds of physicians who cannot bring themselves to say those words. They are generally the ones who get [&hellip;]<\/p>\n","protected":false},"author":1294,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[17,47,37],"class_list":["post-2484","post","type-post","status-publish","format-standard","hentry","category-about-residency","tag-chief-resident","tag-mentors","tag-resident-experience"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v17.1.2 (Yoast SEO v20.8) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>The Power of Intellectual Humility - Insights on Residency Training<\/title>\n<meta name=\"description\" content=\"Dr. Scott Hippe muses about the tendency of physicians to avoid those three little words: &quot;I don&#039;t know.&quot;\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2018\/09\/the-power-of-intellectual-humility\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The Power of Intellectual Humility\" \/>\n<meta property=\"og:description\" content=\"Dr. Scott Hippe muses about the tendency of physicians to avoid those three little words: &quot;I don&#039;t know.&quot;\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2018\/09\/the-power-of-intellectual-humility\/\" \/>\n<meta property=\"og:site_name\" content=\"Insights on Residency Training\" \/>\n<meta property=\"article:published_time\" content=\"2018-09-04T17:34:29+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.nejm.org\/general-medicine\/wp-content\/uploads\/sites\/4\/2018\/07\/AU000_shippe.jpg\" \/>\n<meta name=\"author\" content=\"Scott Hippe, MD\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Scott Hippe, MD\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2018\/09\/the-power-of-intellectual-humility\/\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2018\/09\/the-power-of-intellectual-humility\/\",\"name\":\"The Power of Intellectual Humility - Insights on Residency Training\",\"isPartOf\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\"},\"datePublished\":\"2018-09-04T17:34:29+00:00\",\"dateModified\":\"2018-09-04T17:34:29+00:00\",\"author\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/ee4340cb1857fa1b3e172e9572bf210a\"},\"description\":\"Dr. Scott Hippe muses about the tendency of physicians to avoid those three little words: \\\"I don't know.\\\"\",\"breadcrumb\":{\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2018\/09\/the-power-of-intellectual-humility\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2018\/09\/the-power-of-intellectual-humility\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/index.php\/2018\/09\/the-power-of-intellectual-humility\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blogs.nejm.org\/general-medicine\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"The Power of Intellectual&nbsp;Humility\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#website\",\"url\":\"https:\/\/blogs.nejm.org\/general-medicine\/\",\"name\":\"Insights on Residency Training\",\"description\":\"Observation of residents across diverse medical specialties\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/blogs.nejm.org\/general-medicine\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/blogs.nejm.org\/general-medicine\/#\/schema\/person\/ee4340cb1857fa1b3e172e9572bf210a\",\"name\":\"Scott Hippe, MD\",\"description\":\"Scott is from a small town in western Washington called Snohomish. 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