Self-Effacement

Definitions

1. Self-effacement: Setting aside excessive concern for one's own recognition, advantage, or importance.
2. Effacement of self-interest: Giving the patient's good priority when it conflicts with personal or institutional gain.
3. Professional modesty: Recognizing the contributions of colleagues, teachers, and others to the care we provide.

What Is Self-Effacement?

Patients depend on knowledge and skills they do not possess and are therefore vulnerable to exploitation. Self-effacement answers that vulnerability with service. It concerns financial incentives, professional pride, and the willingness to acknowledge errors, as well as the way we speak about our achievements.

Why Should We Practice Self-Effacement?

• Trust: Patients need confidence that medical judgment serves their interests.
• Conflicts of interest: Attention to competing incentives helps reveal pressures that may distort care.
• Humility: Sharing credit keeps our contribution in proportion and makes room for gratitude.
• The profession: Self-effacement expresses medicine's commitment to the good of the sick.

How Do We Practice Self-Effacement?

1. Keep the purpose in view: Remember that medical knowledge is used for the patient's health and good.
2. Examine conflicts: Discuss competing interests with a trusted colleague before accepting them as harmless.
3. Express gratitude: Name the people whose work, teaching, and support make your care possible.
4. Share success: Give credit fairly and let the quality of your actions speak for itself.
5. Practice service: Attend to another person's needs when concern for your own importance begins to narrow your attention.

Clinical Case

You are a new non-interventional cardiologist in your group out of fellowship for six months. You have rapidly made several friends in your group, connected with many of your patients, and your productivity has been lauded by others. You enjoy having lunch with one of the interventional cardiologists with whom you share many common interests. You love hearing his stories from the cath lab and all the hair-raising clinical situations he navigates through. You finish up lunch after having heard another particularly enticing story of multiple issues deftly managed by your colleague. You leave to go to your first feedback meeting with your group’s leadership, but you can’t help but think that he’s relating it all again as a one-person show.

You walk into your first feedback session confident that you have gone above and beyond what was expected. However, instead of smiles and warm handshakes you are met by grim faces and a curt instruction to “take a seat.” The chief administrator and physician for your group then launch into a speech on the importance of being a “team player” and that is what they’re looking for in future partners. You’re bewildered by this and ask what you have or haven’t done that is not sufficient. The chief administrator then begins to go over the group’s revenue streams and a detailed account of your referral patterns citing that you have not been referring enough patients to your group’s cath lab for diagnostic catheterization. The administrator reminds you that this is where a significant source of income for the group comes from and that this is also a high expense for the group. You were trained to send most of these patients to Coronary CTA rather than invasive catheterization because of the high negative predictive value of CTA and fewer complications even if the test may be a little less accurate when it is positive. Your group’s leadership finishes up by saying that they’ll be following you very closely and they do hope that you’ll see the group’s side of things and become a “team player.”

Sources: LearnWorlds outline; Canva one-pager, page 29.