Humble Pie: The Art of Eating Your Words in Medicine

Danielle B. Cross. MD, MS

Humble pie is best when left to sit out, unmolested, for several hours or possibly even several days. Like a soufflé, timing is everything. What’s it made of? Well, the ingredients are simple:

• A dash of book smarts
• A sprinkle of clinical ambiguity
• A heaping dose of ego

Mix and wait to serve.

Humble pie is an acquired taste. It’s as mandatory a part of the diet of any well-meaning clinician as vegetables so it is incumbent on us to learn how to consume it gracefully and with minimal tears or defensiveness. Some learn this skill sooner than others. Some fight the inevitable and believe they can overcome this doctor vitamin with greater ego or more book smarts.

It’s true that more experience and greater comfort with clinical evidence can reduce the amount of humble pie one is required to eat. However, upon reviewing the ingredients list, you’ll see that it is impossible to avoid cooking up a batch occasionally. Doctors are afflicted with ego as a rule, so it’s only a matter of how much we bring to the baking counter that determines how much pie gets made.

Most important about this concept is the understanding that we are not in control of this kitchen. While only a sprinkle of clinical ambiguity is required to start out a batch of humble pie, we can rarely anticipate how much our environment has in store for us.

I have to admit that circumstances have occasionally conspired to allow me to enjoy watching someone else eat humble pie, a little more than I should have. I imagine being a senior resident is like being an older sibling. There are some lessons you know your juniors have to learn for themselves, and as long as it doesn’t hurt anyone, letting them learn the hard way is sometimes the most effective method.

Recently I was pacing the halls of the outpatient clinic, waiting for my first patient to arrive. I’ve always been a pacer. As a child I loved horses; racehorses in particular, before I learned about the awful conditions many endure without ever winning on the track. They always looked so beautiful, stretching out longer than their body length in a full-on gallop. Before the starting bell ever rings, there is always a profile view of all the horses confined to their temporary stalls associated with their starting positions. Some of the horses would stand calmly while others danced in place. I always understood those horses, fidgeting in place without purpose. Antsy to just get to it.

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I saw a patient that was known to our clinic but not to me personally. She had some abnormal findings on her exam and likely needed more diagnostic studies. As I was staffing the case with my attending, I observed for the first time someone who had reached nirvana level comfort with humble pie.

“We don’t know anything!” she said as she threw both her hands above her head. That was maybe the most reassuring thing I’ve ever heard from the mouth of an attending. Certainty from someone more experienced and more knowledgeable than you’ll ever be doesn’t really inspire warmth. It’s just the status quo. Uncertainty from someone you look up to has more value than any number of years of reassuring words or pats on the back. I was used to the feeling that I didn’t know anything. But to hear it from her made that reality seem tolerable. Normal even. We brainstormed about how to proceed until we came up with what seemed like a reasonable plan.

Comfort with the unknown is ironically something that helps minimize the size of the humble pie. There’s no benefit to testing for everything as eventually, something will return with an abnormal result. That’s just simple statistics. However, there is value in keeping the door to other possibilities open. To keeping an open mind.

To be honest, my patients seem to like the appropriate show of uncertainty as well. They are savvy people and are well aware of when there is more than a sprinkle of ambiguity in their case. This is where the art of eating humble pie enters. At some point, we are all wrong. Experience teaches you it is only a matter of time. How you deal with wrongness isn’t necessarily a given.

My program has recognized this fact. So what do they do? They make us practice being wrong! We have simulations on reporting a mistake that we may or may not have been responsible for.

In reality, the mea culpa is important but it’s not the most important. Our simulation and personal experience taught me that the purpose of humble pie is to remind us that as physicians, none of it is about us. Right or wrong, our patients are the ones that are impacted.

With too much ego in the mix, humble pie can easily go from terrible to intolerable. Humility won’t eliminate this dish, but it can sure help it go down a lot smoother.

This blog has been reposted with permission from amillenialmd.com.

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Danielle B. Cross. MD, MS, is a neurology resident in training with interests in vascular neurology, technology, diversity and inclusion, and education. She has previously taken time away from medical education to work in a small medical startup where she became a believer in work-life balance. She looks forward to fellowship and plans to continue contributing to her blog, amillennialmd.com, and podcast Call Room with A Millennial MD. Follow her on Twitter @amillennialmd.