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Life in Emergistan: The Dangers of Groupthink

Leap, Edwin, MD

doi: 10.1097/01.EEM.0000529867.69905.1f
Life in Emergistan

Dr. Leap is the medical director of the emergency department at Stephens County Hospital in Toccoa, GA; a member of the board of directors for the South Carolina College of Emergency Physicians, and an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available at www.nursingcenter.com, and Working Knights, Cats Don't Hike, and The Practice Test, all available at www.booklocker.com, and of a blog, http://edwinleap.com. Follow him on Twitter @edwinleap, and read his past columns at http://bit.ly/EMN-Emergistan.

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What are we allowed to say as physicians? What opinions are we allowed to express, repudiate, or reject? These are important questions because physicians seem to fall increasingly into a bad tendency of groupthink. And I find that troubling but not surprising.

Groupthink doesn't so much involve issues of science and practice. It has to do with having homogenous views on social, cultural or political issues that determine whether one is the “right sort of physician” or the “wrong sort.”

The collectivization of our viewpoints isn't surprising. Physicians, by the very nature of our similar educational journeys, learn to fit in and please (generally speaking) our colleagues and the people in authority over us, especially those who will influence the trajectories of our careers. We've always been like this; for decades medicine has been a pretty homogenous profession. Even now, we're more similar than dissimilar. Think about all of our friends from medical school or residency. We went to similar schools; we took the same classes (somewhat out of necessity). We engaged in similar volunteer and work activities. We learned the things to say and do to compete for the same coveted residency slots.

Many physicians learned to believe in the same things because of the intellectually consistent nature of modern academia. I mean, deny it if you will, but with relatively few exceptions, the modern campus is quite progressive in politics and culture. The trend continues in medical school. Professors being professors, they're cut from the same cloth; it may be a little different in our clinical years, but the hard science years of medical school are taught by academics who are like other academics. Increasingly, I fear physicians are ideologically the same as well. Or I should say, physicians willing to speak in public forums (and not fearful of being attacked) are ideologically the same. The problem isn't that so many physicians have the same ideas or politics; that's fine. It's that ideological consistency has a tendency to make people think that those who hold different views are not only wrong, but stupid; not only stupid, but evil, and as such, should not be heard.

Admittedly, we are now a much more diverse profession than we were in the past. Still, even as we embrace diversity on many levels, we seem to expect conformity of thought more than ever. Ironically, this is a thing that flies entirely in the face of our superficial calls for diversity. The rule is apparently as follows: “Be yourself! Be unique! Bring your special cultural, racial, gender, sexual, and national qualities to our workforce! Please think like everyone else!”

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A Science of Humanity

Do we as physicians want safe spaces as well? It certainly seems, from our behavior in some online forums, as if physicians follow the same trend. I have been on the receiving end of this behavior myself. I was once told my viewpoints weren't welcome because I am a straight, white man. Fearful of being offended or of offending, fearful that an unpopular thought might see the light of day, question a prevailing view, we cull the herd and cut out those who don't fit in until we are all the same. But what will that do to the future? For our students and residents? And what will it do to our ability to use science in our practices?

I would venture to say that this tendency to run with the group, think like the group, and eject others will degrade the profession and the science behind it. Medical science requires dissent and challenge to be a science. And a science as full of humanity as ours requires different cultural backgrounds and ideas in its practitioners (and their families) because our patients are widely divergent as well.

Imagine, however, if we tried to have a frank scientific discussion in an EM forum about concerns practitioners have about transgenderism as a body image disorder? It would be shut down immediately as hate speech in violation of the established groupthink. What will happen when physician-assisted suicide becomes an expectation and it falls on the ED? Will those who have a faith-informed objection be welcome in the discussions or marginalized as “unscientific” and told to leave their beliefs at the door? I think I know; I hope I'm wrong.

Despite the consistency of many discussion forums, conferences, articles, and much of the house of modern medicine, it would be wise for everyone to remember that there are vast numbers of physicians out there who live in silent disagreement. They're silent because they know they risk attack and marginalization if they speak. But they have something to offer us all.

Let's offer them a seat at the table and dispense with groupthink. Everyone will benefit. And in the end, the patients will benefit most of all.

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