LAUSR

Paediatricians are less likely to make medical students feel humiliated than their adult physician counterparts. That is the good news for paediatricians. The bad news is that 29% of medical students experienced teaching by humiliation during their paediatric rotation, and 45% witnessed it. There are more and longer adult rotations, so paediatricians cannot be smug that the respective figures for adult rotations are that 74% experience and 84% witness teaching by humiliation. The first response by many paediatricians is to say that students nowadays are softer than we used to be and cannot accept criticism, that is, the classic victimblaming defence. Students dislike being grilled with aggressive questioning intended to shame them by highlighting their knowledge gaps. Whether or not paediatricians were taught the same way and think it was character building and did them no harm, the counter-argument is that it harmed them enough that they lack the insight to recognise that it is unacceptable behaviour that can be categorised as bullying. Atul Gawande is a surgeon and Harvard professor who conducts public health research and is a brilliant writer. In two of his acclaimed 2014 Reith lectures, the full transcripts of which are freely available on line, he discusses ‘Why do doctors fail?’ and ‘The problem of hubris’. When doctors fail, he says, it is due to ignorance (no one knows but we can try to find out), ineptitude (we do know, but the treating physician does not apply the knowledge correctly) and necessary fallibility (no one can possibly know). Gawande was concerned about people with terminal illnesses and a prevalent belief that we should be able to cure everyone, which he describes as a 50-year experiment with medicalising mortality. His antidote is to ask people with advanced cancer what are their priorities and work towards helping them achieve those. Gawande describes hubris as overweening confidence and says doctors should admit we cannot cure everything. Hubris is an ancient Greek concept, considered the greatest crime possible by the Gods. Humans exhibited hubris if they stole from the Gods or if they compared themselves to the Gods. Prometheus stole fire from the Gods and gave it to mankind; his punishment was to be chained to a rock and have his liver pecked out daily by an eagle, only for it to grow back that night. The Greeks may have known that the liver is the only organ that regenerates. Tantalus dined with Zeus in Olympus but stole ambrosia and nectar to show off to mortals; his fate was to stand in a pool of water beneath a tree with low-hanging fruit. Researchers sometimes talk about the need to pluck low-hanging fruit, that is, do the most feasible research. Whenever Tantalus tried, however, the branches rose out of reach. When he tried to drink, the water receded. Tantalus’ name is immortalised in the word ‘tantalising’. Women are not exempt: Arachne claimed she had won a weaving contest against the goddess Athena, who turned Arachne into a spider for her hubris. Arachnids come from Arachne. Sisyphus gave away the whereabouts of one of Zeus’ ‘conquests’ (Zeus was as much a rapist as an artful seductress), the nymph Aegina, to her father the river god Asopus. Fig. 1 Humility. Stained-glass window in Rochdale Unitarian Church, designed by Edward Burne-Jones and manufactured by William Morris. doi:10.1111/jpc.13801