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Practicing medicine with conviction

What does it take for physicians to practice with conviction – to practice medicine with a sense of confidence and commitment, passionate about your work? What factors allow medical students to enter the resident pool each July and turn their timidness into poise? How do you learn to stand by your medical convictions and base your decision-making on a deep understanding of the patient combined with the latest evidence-based practices? Here are a few thoughts that come to mind.

First and foremost is continuous learning. You can practice with conviction by being well-informed and up-to-date about the latest medical advancements, research, and practices. This includes attending medical conferences, participating in professional development activities, and reading the latest medical journals.

I suggest you read (or skim) at least one major weekly medical journal each week, like the New England Journal of Medicine or the Journal of the American Medical Association, and two highly regarded journals in your specialty. A daily or weekly online newsfeed is also useful. Why not listen to a podcast on your way into work?

The pace of medical advancements can sometimes be overwhelming, making it challenging for you to stay updated. You must find the time to read; however, because reading bolsters your confidence and strengthens your commitment. During rounds, I frequently distributed articles relevant to patients on our service, and I was proud to be called “Article” Lazarus by the house staff. I could always take a ribbing in the name of patient care.

The more knowledge and experience you have, the more conviction you will have in your decisions and actions. This comes from years of practice, dealing with various cases, and learning from successes and failures – and you will fail, make no mistake about it. The Institute of Medicine wrote “To Err is Human.” I keep a placard in my office that reads: “I am willing to make mistakes if someone else is willing to learn from them.”

Doctors with conviction are able to empathize with their patients. They understand their concerns, fears, and expectations, which helps them provide the best possible care. We must never let our empathy wane. When choosing a physician, patients value affective concern as much as, if not more than, technical competence. I am dismayed by studies showing empathy decreasing midway through medical school, before doctors are newly minted. Medical students should realize that physicians who are more attuned to the psychosocial needs of their patients are more likely to have better outcomes.

A physician practicing with conviction adheres strictly to medical ethics. This includes respecting patients’ rights, maintaining confidentiality, and avoiding any form of discrimination. We are at a tipping point where the promulgation of diversity, equity, and inclusiveness initiatives is beginning to eradicate barriers to treatment for minority populations while promoting a more diverse physician workforce. Diversity – or the lack of it – among medical students and physicians affects not only how care is delivered but also the ability to make clinical decisions with conviction and courage.

A nurturing environment is essential to practicing with conviction. Trainees are more capable of rising to a clinical challenge when they are respected and treated well. Our collective experience reveals that it is not a health system or long working hours that guarantee residents become excellent physicians; it’s the conviction and dedication of the people within those systems and who schedule the hours.

In order to practice with conviction, certain barriers must be overcome. The most important is imposter syndrome (IS). People often think of imposter syndrome as a lack of self-confidence, and although that is certainly a feature, the hallmark of IS is an internal feeling of intellectual phoniness, a persistent belief that you are really not bright and have fooled anyone who thinks otherwise. Individuals with IS are high achievers, but they doubt their accomplishments and believe they are unwarranted.

Anyone who dreads being exposed as a “fraud” cannot practice with confidence. You will be saddled with doubts and fears of failing, as well as constant anxiety. Physicians with IS may be less likely to seek help or advice from their colleagues due to fear of appearing incompetent. This can hinder communication and teamwork, which are crucial in the management of patients.

A lack of confidence can also be perceived by patients, potentially undermining their trust in doctors and the profession. The first time I was called on to perform venipuncture on a patient, I was a nervous wreck. My hands were trembling. The patient was keenly aware of my insecurity and refused to allow me to draw blood. My confidence was shaken, and I shied away from performing procedures afterward.

Imposter syndrome can become a self-fulfilling prophecy because it keeps physicians from achieving their full potential. They develop an aversion to being in the spotlight and turn down leadership opportunities. For these reasons and others, discussions about IS should be integrated early into medical student and residency wellness programs and initiatives. Students deeply affected by IS, believing they are truly fakes, should seek psychotherapy.

There may be several conditions other than IS that affect physicians’ commitment to practice. Prominent among them is burnout: exhaustion, cynicism, and reduced professional efficiency. Burnout clearly affects doctors’ commitment and passion for their work. A major cause of burnout is chronic stress often brought on by practicing with limited resources, whether it’s time, staff, equipment, or funding, which can prevent physicians from providing the best care possible, affecting their conviction. Physicians can take action to prevent burnout and seek help early when it occurs, restoring their commitment to practice.

Systemic pressures – pressures from insurance companies, hospital administrators, and many other parties tied to the “medical-industrial complex” – can sometimes force doctors to make decisions that they are not entirely comfortable with, thereby affecting their conviction. Moral injury resulting from the failure of health systems to protect physicians during and after COVID has made them rethink their commitment to medicine. Health care institutions should focus on administrative and climate interventions to prevent and address moral injury.

Finally, clinical uncertainties and treatment ambiguities can sometimes affect a physician’s conviction, especially in the context of malpractice litigation. Simply the fear of litigation can make physicians practice defensive medicine rather than making decisions based solely on their professional judgment. The manner in which doctors deal with uncertainty affects their emotional well-being and ultimately their conviction to practice. Your interest in and commitment to practice will skyrocket once you learn that medicine is not always black and white and develop skills to better tolerate ambiguity.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.

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