Enough with the Academic Arrogance

By Joanne Conroy, MD

Google “academic arrogance,” and you will see that it is not just a problem in the United States but in many countries and cultures. Unfortunately, Americans usually do things bigger and better.

Academic Medicine published an article by Allan Berger, MD, in 2002, entitled “Arrogance among Physicians.” Berger wrote,

Arrogance among physicians is, regrettably, common and detracts from the nobility of our profession, its dignity, and the quality of medical care. Arrogance may be manifested in diverse ways, such as lack of proper respect, consideration, and good manners toward patients, nurses, and other ancillary staff; failure to pause, listen, and share a friendly word or two; being abusive or critical of subordinates, sometimes even in the patient’s presence.

This assertion seemed to land with a thud. There were few follow-up articles and minimal commentary in response to Berger’s timely piece. That is unfortunate, because coming to grips with academic arrogance is critical to our ability to function effectively in teams as we care for patients.

Talking about academic arrogance in medicine is akin to a public display of flatulence: Everyone hears it, laughs nervously, and quickly changes the subject. We believe that arrogance in academic faculty may lead to under-reporting of near-misses and adverse events, and delays appropriate escalation of notification when patients are quickly “going South.”

It has been 10 years since Berger wrote his article. Are we in a different place? Would our academic faculty confirm that they are being rewarded for a different type of role modeling? If the answer is no, are we so immune to the consequences? Are we arrogant because of what we know, or because of the power that that knowledge conveys?

I recently attended a discussion at a national specialty meeting about implementation of the WHO surgical checklist, an initiative that has demonstrated decreases in the morbidity and mortality of surgical procedures if appropriately used. Representatives of many community hospitals discussed the challenges of full implementation, but representatives from academic medical centers complained that they couldn’t even launch the initiative due to institutional resistance to “cookbook medicine.”

Really? Do AMCs really think we are better than our national peers? Have we looked at our own data recently? National quality and patient safety proponents are tired of running into the closed doors of our hallowed halls.

Plus, I thought we were past the “not invented here” philosophy. It is narrow-minded and does not befit real scientists.

Show me a survey that says academic medical centers are head and shoulders above community hospitals. We can artfully explain away each individual negative survey, but at what point do we acknowledge that the burden of data from multiple sources is disconcerting?

Berger concludes his article by reminding his fellow physicians that we should not exaggerate our own importance: “We are but an instrument of healing and not its source.”

When I complained, as a first-year medical student, that I didn’t have time to wait in bank lines, my then-husband said, “When you start thinking you are better than other people because you are a doctor and the rules do not apply to you, that’s when you stop deserving the privilege of being one.”

–Joanne Conroy, MD, is Chief Health Care Officer at the Association of American Medical Colleges. She can be reached at jconroy@aamc.org. Follow her on Twitter @joanneconroymd.

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