Definitions
- The quality of not making yourself noticeable, or not trying to get the attention of other people.
What is Self-Effacement?
- Although self-effacement may mean shy or introverted, being modest may be a better synonym for the self- effacement needed in medicine.
- Self-effacement in medicine can be applied in several areas.
- Self- effacement is a defining obligation in all professions
- “Those who need professional help, by the nature of their need, are eminently vulnerable and exploitable”(Pellegrino E.D.)
Why should we practice the virtue of Self-Effacement?
- “Effacement of self-interest in treating the sick has been a duty binding all physicians beyond historical, cultural, and religious boundaries” -- Dr. Ed Pellegrino.
- By “sharing success,” we will inspire others and cultivate a spirit of gratitude to the many contributors that make modern healthcare a success.
- We all tend to think of ourselves as “better than average” but having allocentric and altruistic goals can reduce negative emotions towards others which are caused by the BTA effect
Aristotle’s Doctrine of the Mean
Aristotle’s Doctrine of the Mean emphasizes balance as the essence of virtue, symbolized here by a mountain peak with a flag representing the ideal midpoint. Each virtue lies between two opposing vices—deficiency depicted on the left, and excess, on the right slope. For example, courage is the balance between cowardice (deficiency) and recklessness (excess). In a medical context, this principle guides healthcare professionals to strive for the peak of ethical behavior, avoiding the pitfalls of extremes to ensure thoughtful and compassionate care.
Case Studies
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.”
Discussion Questions
- How would you respond to the group’s leadership?
- What is the tension amongst the self-interest of the group, the cardiologist, and the patient?
- Who may stand to lose the most of these three? “When the physician is deliberately made the agent of his or her own interest rather than the patient's interests, the patient's welfare is clearly endangered” – Dr. Ed Pellegrino. Is Dr. Pellegrino’s statement correct?
- How do physicians lose by not effacing their self-interest?
- How do you go about weighing various self-interests?
- How do changes in technology affect medicine and finances?
- Are Drs. Pellegrino and Reiman correct about self-effacement being at the heart of medicine as a profession?
- Drs. Pellegrino and David Thomasma identify 8 core virtues for medical practice: fidelity to trust, compassion, practical wisdom, justice, fortitude, temperance, integrity, and self-effacement. How do the virtues especially justice and fortitude contribute to self-effacement?
- What happens to fidelity to trust if effaced self-interest is not practiced? Is caveat emptor (“let the buyer beware”) a satisfactory ethic for healthcare?
- Effacement of financial self-interest is certainly a strong flashpoint within American medicine, but how else is self-effacement needed within medicine?
- Medicine is a highly complex endeavor. How can we mindfully incorporate the sentiment “standing on the shoulders of giants” into our practice and our lives?
- Do physicians have a professional obligation to treat infectious patients especially during pandemics?
How do we foster Self-Effacement?
- Verbalize gratitude to others for their contributions to healthcare.
- Remind ourselves and others that the purpose of medicine is to promote the health of the patients.
- Identify conflicts of interest during a patient encounter, discuss with a colleague or trusted friend, are we acting upon our own self-interest above the patient’s best interest.
- Show excellence through actions instead of boasting about it through speech.