After the Match: The Courage to Look Stupid

Cook, Thomas MD

doi: 10.1097/01.EEM.0000515687.45047.2d
After the Match

Dr. Cook is the program director of the emergency medicine residency at Palmetto Health Richland in Columbia, SC. He is also the founder of 3rd Rock Ultrasound (http://emergencyultrasound.com). Friend him at www.facebook.com/3rdRockUltrasound, follow him on Twitter @3rdRockUS, and read his past columns at http://bit.ly/EMN-Match.

Article Outline

My “hobby” career is running a CME course on bedside ultrasound that I put together back in the 1990s. Surprisingly, we are still in business, and we just completed our annual course. I have lectured for almost 20 years in 12 different countries to attending physicians, medical students, nurses, EMTs, PAs, NPs, and residents on how to use ultrasound in the ED.

I also discovered the common barrier in the learning process. I have noticed many physicians take the course more than once. I suspect the vast majority did not integrate the technology into their practice after they went home, and they had to keep coming back to relearn the same set of skills. I always ask these docs why they are back. Their reply usually sounds like someone who tried and failed to quit smoking or lose weight.

They were enthusiastic about changing how they practiced medicine after their first course, they fell back into old habits after a few weeks. Many said it was taking too much time. Nurses and their partners seemed annoyed with any perceived delay in patient flow. Consultants and other health care providers belittled them by saying that they didn't know what they were doing. This made them self-conscious about using ultrasound at all.

My intuition tells me that it is the fear of looking incompetent that is the primary barrier to adopting any new technique, but you can learn and eventually help your patients with your knowledge if you have the courage to look bad when trying something new. The lofty status occupied by attending physicians, however, almost always gets in the way.

For millennia, healers have been admired for their wisdom, and, unfortunately, it goes to our heads. We fear looking bad because many people think we are proficient and smart. So we feel ashamed when we challenge ourselves by learning something that less-trained individuals (e.g., ultrasound techs) do effortlessly.

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Be Pig-Headed

Many years ago, I was the guy learning how to use ultrasound. All I had was a beat-up machine and an old textbook. I scanned as many patients as I could to try to learn on my own, but it took a lot of time. I heard complaints and read them on my evaluations. People poked fun at me (they still do), and a radiologist attacked me over the salad bar in the doctor's lounge by saying that I was unqualified to do ultrasound.

But I was (and still am) pig-headed and kept at it. Nonetheless, I can understand how folks loaded with enthusiasm when they leave our course would cave under the pressure to give up because of the negative reactions they receive for trying something new in the ED.

One of the privileges of residency is that it is acceptable to look stupid. You quickly realize that if you want to develop expertise in an area, you have to try it again, and again, and again. Residents exhibit little shame in seizing opportunities to intubate, put in chest tubes, or place central lines. It's unpleasant when they are unsuccessful, but they are willing to try because occasional failure is expected, and health care providers of lower status (i.e., nonphysicians) are not the personnel who would step in when they cannot do it. Only an attending or upper level resident will take over, so the loss of prestige is minimal. A resident might be reluctant to try if a nurse were to take over, however. Have you noticed how medical students are willing to attempt IVs, but physicians will almost never do this?

Maintain the courage to be occasionally incompetent. Do not let failure get in the way of your future advancement, and do not let prestige get in the way either. You can learn a lot from nurses, respiratory techs, ortho techs, physical therapists, and EMS personnel, and they will love it when you seek them out for advice.

When they feel that you are open to their input, they will think more of you as a physician and not as someone hung up on status. Finally, do not let your passion to learn after residency be derailed by peer criticism. Negativism is easy, and maintaining the drive to acquire new skills is hard. Ultimately, this will be the intellectual glue that will keep you engaged in your profession in the long run.

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