I remember when I started fellowship, I thought that I knew more than non-intensivists about critical care, even though I hadn’t really paid my dues yet. I had started learning, of course, and was well-read and knew some of the more active guidelines. I knew, for example, that giving blood for mild anemia was largely falling out of practice. Yet, I had very little experience making that decision in a, say 75-year-old who was struggling with hypotension after an aortic valve replacement and coronary bypass procedure. Yet I was convinced of my “rightness,” and argued to not give blood but to give crystalloid, vasoactives and the like.
Now, I may well have been “right,” according to published data. Which, for the record, is not the easiest to interpret in the cardiac surgery population! But I was wrong. Wrong to not value the experience of phenomenal surgeons, with years of covering critically ill post-operative cardiac patients without my help (or any critical care doctor’s help!).
I’ve gotten older, hopefully a little wiser, and I’ve seen these two issues time and time again. On one hand, we assume expertise based on our choice of field, instead of our experience. A second-year anesthesiology resident may have an excellent fund of airway knowledge, but a grizzled and experienced emergency physician at Hennepin may well be who I pick to intubate my family member. And the opposite is also true: emergency medicine physicians frequently think their experience – even if limited – in emergent airways somehow makes them the experts at the procedure, even compared to a 1500+ intubation anesthesiologist!
What is best for our patients, and ourselves, is humility. Now, when I hear the word humility, I think it is used incorrectly 90% of the time. It is not “humbling” to make it to the Super Bowl, or to gain national recognition for what you’ve done – it may well be astonishing that people are so interested, or make you feel thankful, or shy, or a million other things. But this is not humility. And in the work of a doctor, it isn’t always good to be humble. I should not casually step aside and assume that whoever is walking to the head of the bed is as good or better than me at intubating a severely decompensating critically ill patient. Few are, so it’s important for me to be proud, step up and take over. Being humble isn’t helping anyone.
Humility in the medical world should be put more simply: “To Value Everyone’s Input.” I am intrigued to hear an emergency physician’s approach to a vomiting airway. Even different than mine, it may have value for me, or for another intubating proceduralist who may do it only emergently, and only every other week. It is valuable. And while I sure thought I was hot-stuff with my newly acquired ICU knowledge, the cardiac surgeon with years of experience has gut intuition and years of knowledge, and a “this tends to work” history that has massive value.
Humility doesn’t mean that I accept that someone else is right, or that more experience means that their clinical judgment is by default correct. But it means that I value their experience and knowledge. You are not an expert in isolation; you are an expert after combining learning with exposure and experience. And valuing everyone’s input is something we can all work on.