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Volume 1, Issue 2
Summer 2005:

Letter to the Editor: Criticism

Richard Sobel, MD

Cell 2 Soul. 2005 Summer; 1(2):a6

"Rate the individual on a sliding scale from 1 to 5, one being best and five being worst." I used to dread meeting with the attending physicians at the end of a house-staff rotation to assess the residents. It always seemed inherently repugnant to rate people on a numerical scale. The form we used listed some twenty questions assessing the person's personality traits and professional skills: a question that particularly bothered me was, "how does the resident accept criticism?" How does one answer this question without knowing why the person was being criticized and how the criticism was delivered? Was the individual apparently guilty of a moral lapse or responsible for a near fatal therapeutic misadventure; or was the critic just taking the resident to task for an annoying personality quirk?

Setting aside the question of what prompted the criticism, there is the equally important matter of how well did the critic criticize. Criticism can be humiliating, cruel, arrogant, disproportionate and destructive or — understanding that we are all fallible — it can be given with some compassion and balance and with a clearly constructive intent. The incident may be serious enough to justify punishment, perhaps even criminal proceedings; but, more often, even an 'iron fist in a velvet glove' will be overdoing it. In most instances, rather than criticizing a particular individual the emphasis should be on the system — was there a way to have prevented the mistake?

The first issue of Cell 2 Soul included two articles criticizing physicians (June Bingham's "Some Doctors are From Saturn") and dental surgeons (Shannon Brownlee's "Tales From the Clinic").

In a letter (a "thundergram") to her cardiac surgeon, Bingham criticizes him for his behavior toward her. However, she decided against giving him the letter (or sharing it with the reader) and, instead, published the Cell 2 Soul article about him and about the cardiologists who had examined her. She does not question his technical competence or medical judgment, but finds him a boor. Without ever acknowledging her existence, he repaired her pacemaker. An electrician who came to her house to repair an outlet would have said "good morning," exchanged a pleasantry or two and said "good bye" The surgeon barely took note of her, and the cardiologists who had seen her in the clinic were not much better. Bingham is justifiably critical; moreover the criticism is proportional, balanced and delivered with a sense of humor. Of course, humor can be used as lethal criticism — what better way to deflate dignity than to make someone appear laughable? — but that is a separate subject. I think that if the surgeon she described came across her article, he would probably have read it from beginning to end and might even have learned something from it.

The Shannon article concerns a more serious situation. The author attacks the dental surgeon for flaws in his personality and for limitations in his professional competence. Whether or not it was the author's intention, I got the impression that the dentist was primarily motivated by greed, that his professional competence was questionable, and that he didn't really know what he was doing or the basis, if any, for his recommendations. The criticism is harsh, bitter, and absolute even though, in the post-script she acknowledges that the surgeon she consulted for a third opinion agreed that the proposed surgery was indicated. If I were a medical ombudsman and had received her article as a formal complaint, I would have asked the orthodontists and surgeons for their version of the story — expecting that the situation would be much less black and white than it seems from Brownlee's account. For example, her complaint that no clinical studies had been done is not accurate. There are no double blind randomized studies (if such a study could even be done) but a quick search in PubMed yielded several observational studies showing generally favorable outcomes for the dental surgery she is facing. Brownlee has good cause for being angry at her fate, cursing her situation, and having no fondness for her dentists, and distrusting their advice; but I wonder if this bitterness at her fate colored her perceptions and if the dental surgeon may not have been quite as awful as described. If he were to read her article, my guess is that he would be angered, might not finish it, and would want to respond to it. Would he have learned anything from it? Criticism was called for, but might it have been more effective if delivered in a constructive and less one-sided fashion?

Everyone is subject to criticism, and it is important to know how to accept justified criticism graciously and to profit from the experience. But it is no less important to know how to criticize — to be fair, balanced, understanding, in proportion and constructive, not only because this is a kinder, more humane way to behave but because it is a more effective way to criticize.

Yours truly,

Richard Sobel, MD
Kibbutz Revivim, DN Halutza 85515, Israel

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