Looking back over the first 2 days of the Telluride experience, I am a little concerned but not entirely surprised at how many of our discussions have centered around fear-based decisions. Why are we uncomfortable with breaking bad news? We are afraid of how the family may react. Why do we avoid disclosing medical errors? We fear retaliation, litigation, being seen as less than. Fear prompts us order unnecessary tests, imaging. Fear drives us to pretend that we are infallible. Fear prevents us from speaking up when we disagree with a superior’s management. Medicine has become a culture of fear, our patients, their diseases, society, are all threats, ready to pounce on us when we make the first tiny mistake. But how can we care for patients properly when we live in trepidation? How can we care for ourselves and find fulfillment in our work if we are constantly looking over our shoulder? Is this yet another byproduct of the malignant “culture of medicine”, or is this something inherent in the nature of the profession, fallible beings trying to work in a field that demands infallibility?
