Please, stop revealing the guild's secrets
CMAJ 1999;160:1289
It was with horror and outrage that I read the article by Donald Redelmeier and colleagues [full text].1 My chagrin is best captured by a quotation from that eminent physician and surgeon, Major Frank Burns of the 4077 M*A*S*H: "I resemble that remark!"
To suggest that the "art" of obfuspeak on ward rounds can be reduced to simple guidelines, as these authors suggest, is an insult to all hard-working academic attendings. What would they suggest next? That we develop a scale for measuring waffling? This article exemplifies all that is evil about the practice of evidence-based medicine. (And remember, in Saskatchewan we have a long tradition of disdain for EBM.) I will provide a few examples.
First, the art of obfuspeak is an ancient medical tradition. I endured it as a resident, when I learned it from the best practitioners. All the best residents seem to learn it without guidelines. It is my duty to pass it on.
Second, evasion and distraction are complex, subtle arts. They cannot be broken down into component parts like some car. Surely the good I do by creating an air of superiority inspires confidence in me (and hence in my treatment methods), and this in turn benefits residents and patients. I know it works, so what more proof is needed? My craft has been carefully honed over time. I will not (and in fact cannot) put it into words, and hence measurable units.
Finally, the guidelines do not apply to me. My residents are not like those implied in the article. My methods are subtler and my practices different. Am I now at risk of a college reprimand for deviating from these guidelines on waffling published by CMAJ?
Buried in the article, however, is a sage bit of advice. Reading should be avoided. I plan to give it up soon. I also plan to give up teaching if Redelmeier and his colleagues ever give away the secret attending handshake.
Paul M. Peloso, MD
Department of Medicine
University of Saskatchewan
Saskatoon, Sask.
pelosop@shaw.wave.ca
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Reference
- Redelmeier DA, Shuchman M, Shumak SL. How to read clinical journals: IX. Sounding like you've read the literature when you haven't read a thing. CMAJ 1998;159(12):1488-9.
