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Letters to the Editor

In Reply to Shah et al

Caruso Brown, Amy E. MD, MSc, MSCS

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doi: 10.1097/ACM.0000000000003200
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I thank Shah and colleagues for their comments on my Teaching and Learning Moments essay. I wholeheartedly agree that mistreatment in all its forms—not only humiliation but also cruelty, harassment, and discrimination based on race, ethnicity, religion, gender, sexual orientation, and other personal characteristics—must be taken seriously. Indeed, as I suggested in my essay, the growing emphasis on student satisfaction and the avoidance of discomfort in American medical education have obscured the very real problem of mistreatment. For this reason, I think Shah and colleagues have missed the point: we, as current and future health care professionals and as lifelong learners and teachers, should not have to choose between practicing humility and avoiding humiliation.

Being treated and treating others with respect and compassion are crucial to the goals of medical education and health care, but they are not enough. Patients want and deserve their doctors to be both kind and competent, and rightly so. The physician who never learns humility, who cannot tolerate the discomfort of uncertainty and ambiguity, and who fails to acknowledge and reflect upon mistakes is a danger to patients. We have a duty as medical educators to do what we can to make sure our graduates do not become that physician. This does not mean that we should humiliate our students, but rather that we must cultivate their humility by giving them space to experience being wrong in a setting where their errors cannot harm patients and to learn from that experience how best to respond to uncertainty and error.

Amy E. Caruso Brown, MD, MSc, MSCS
Associate professor of bioethics and humanities and pediatrics, SUNY Upstate Medical University, Syracuse, New York;; ORCID:

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