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After the Match

After the Match

The Last Time Someone Tells You the Truth

Cook, Thomas MD

doi: 10.1097/01.EEM.0000651008.12077.a0

    Humans put a lot of value in truth, but do we really want the truth? It reminds me of a lecture by Greg Henry, MD, in which he said, “Do I really want to know if my wife is cheating on me? After all, everything is going pretty well. The kids are happy. My job is great. I am enjoying life. If I find out she is secretly seeing someone else, I will be miserable.”

    In other words, is it better to live in a happy fantasy or be sad in a problematic reality?

    Everyone in your life sees a different you, and getting access to these perceptions is nearly impossible. Some may think you are a great doctor who they would trust with their family. Others may think of you as the person who always shows up late for shifts or turns over poorly worked-up, complicated patients at checkout. They will, however, rarely tell you this to your face.

    Unfiltered truth is faced by emergency medicine residents at least twice a year. They meet with their program director to review their evaluations and find out what people really think of them. But do they want to know? They have enough stress in their lives without being forced to review a list of their shortcomings.

    Instead of thinking of it as a painful ritual, I would suggest that residents think of it as the last time anyone you work with will tell you the truth. Once you leave residency, it will be unusual that your colleagues and partners honestly tell you what they think of you. You might even be close friends with them outside the ED, but they will rarely be candid about your performance at work. They might even lie to you about how great you are. Everyone wants to be liked, and throwing around compliments is an easy way to get people to think you are wonderful.

    These “lies” are often social lubricants that help us form close bonds. Can you imagine a group of physicians who are always honest with each other about everything? I have been with some of my partners for more than two decades. They are great people, but we all know each other's shortcomings. After all, we have spent an enormous amount of time with each other under difficult circumstances. We do not candidly tell each other what we do wrong or what annoys us. We have to be willing to overlook each person's faults and fawn over what they do well. This is how all human relationships survive.

    Not about Grades

    You have a precious opportunity in residency, however, to get unfiltered information on what you do right and wrong. It is unlikely that you have ever received this information before. Sure, you had a few med school rotation evaluations with some criticism. This is nothing compared with the unfettered comments on an evaluation from a fellow resident or attending. But to make this work, anonymity is key.

    Without fail, my residents want to know who submitted a critical comment about them. They naturally think that getting a better eval in the future can be accomplished by doing specific things when working with that person.

    But you will not get complete honesty if you do not have anonymity, and at best, you will get half-truths. Most evaluators will seek to avoid conflict. Occasionally, some will say they tell it like it is, but no one can do this for everyone they work with regularly. Humans are conditioned to lie to maintain good relationships.

    The goal of residency is not to get a good evaluation. Residency training is not a school. Good grades will not get you where you want to go. See the forest, not the trees. Don't focus on one criticism that may have been created by a difficult scenario when you were not at your best. Instead, look at the overall trend of what is said. One criticism is almost always an anecdote. Six comments about being late for shifts or conducting sloppy checkouts are a call for change. By adopting this approach, you avoid the perception that you are passing or failing an evaluation, and instead focus on the skills you need to develop for a successful future.

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    Dr. Cookis the program director of the emergency medicine residency at Prisma Health Richland in Columbia, SC. He is also the founder of 3rd Rock Ultrasound ( Friend him, follow him on Twitter@3rdRockUS, and read his past columns at

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