Be Brave

Hi everyone:

On the train to New York yesterday, I got a Twitter alert from one of our pulmonologists, Lauren Ferrante, referencing a five-year-old editorial by Harlan Krumholz of our cardiology section. The piece was called "A Note to my Younger Colleagues...Be Brave," and I immediately clicked, knowing I wouldn’t be disappointed. Dr. Krumholz can always be counted on to question entrenched ideas, promote transparency and integrity, and say something worth sharing. Although nominally about cardiovascular research, his editorial has implications for us all.

Transformative breakthroughs depend on brave investigators. Barry Marshall was initially marginalized for proposing that H pylori caused peptic ulcers. Eugene Robbins was considered a renegade for disparaging the Swan Ganz catheter, years before studies showed its uselessness in treating ARDS and sepsis. As many as 50% of intubated asthmatics died before Darioli and Perret showed it was safe to let CO2 levels rise. Each of these physician-scientists fostered breakthroughs because they made careful observations, communicated their findings clearly, committed themselves to answering important questions, and found the courage to challenge dogma.

Every day presents us with opportunities to create change, not just in medical science. We can intervene when we see errors committed. We can question treatment plans that make no sense. We can advocate for patients to get the care they need. We can give honest feedback to colleagues instead of empty praise. We can speak up about ways to improve the residency, because candid suggestions are priceless.

We can and should be change agents outside the hospital. Our status as physicians puts us in a powerful position to advocate for access to healthcare, for research funding, and for an end to discriminatory practices. Equally important, we can advocate for diversity, inclusion, respect, and collaboration in our workplace.

It takes courage to be a change agent, but you don't have to be Wonder Woman or Superman. The fear of speaking up almost always exceeds the actual risk, and doing so becomes much less scary as you build your skills. Here are some preliminary suggestions for becoming an effective advocate, gleaned from my own experience (and mistakes):

1. Speak your truth quietly and clearly. You want to persuade and influence people, not make them hostile and defensive.
2. Investigate the causes of the problems you want to solve. Causes aren't always immediately obvious, and solutions that fail to address causes are destined to fail.
3. Remember that most of the people you work with are reasonable and want the same things you do. Don't let tribalism blind you to the good intentions and talents of those outside your inner circle.
4. Open yourself to criticism. Let criticism sharpen your thoughts, challenge your assumptions, and hone your message. Criticism is a gift, even if it’s painful.
5. Let your core principles drive your work. Whether you want to advance medical science, improve clinical care, or promote social justice, commit yourself to your core. Whatever the outcome, you'll be proud of your work.

It's a gift to be a physician, particularly here and especially now. The value of this gift can only be measured by the way you choose to use it. Don’t be discouraged or overwhelmed by the recent resurgence of ignorance, hatred, and bigotry. Now more than ever, the world needs your talents, energy, and integrity. Commit yourself to high ideals. Be a change agent. Choose to be brave.

Enjoy your Sunday, everyone,

Mark