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Questioning Medical Traditions

The U.S. consumes about 46 million turkeys every Thanksgiving. Have you ever wondered why? When traditions take hold in society, we start to forget why they existed in the first place. For example, the tradition of eating turkey on Thanksgiving started with a writer named Sarah Josepha Hale, who published scenic depictions of American life in New England. She subsequently campaigned for everyone to adopt her depiction of a cooked turkey and togetherness while tensions in the nation mounted during the Civil War era. Hale’s campaign contributed to Abraham Lincoln declaring Thanksgiving a holiday, and turkey became a staple at dining tables across the country. Asking why we eat turkey on Thanksgiving shifts the tradition from being dogmatic to having purpose, which is to promote togetherness among the American people.

Medicine is not immune to this phenomenon of forgetting the origins of ubiquitous traditions. Providers don a white coat that is covered in potentially pathogenic bacteria, which was initially used as a technique in antisepsis. We swear to multiple different Hippocratic oaths, none of which can be definitively attributed to Hippocrates. The irony behind some medical traditions is hidden in plain sight. Their ubiquity invites complacency. We may not think about the pros and cons of these traditions just as we may not think about why we eat turkey on Thanksgiving. This indifference is fine for poultry, but not when it comes to medical care.

The malice in medical traditions going unnoticed is not only ironic perpetuation, but also that they slipped through the scientific revolution unscathed. Our field, which prides itself on scientific methodology and empiric evidence, shouldn’t hinge such commonplace practices on “that’s the way we’ve always done it.” Our physical exams should be intentional diagnostic reasoning, not an outdated routine practice. Our medical education should focus on yielding the best 21st-century physicians, not perpetuating 19th-century courses.

The point is not that traditions are inherently bad. I love Thanksgiving turkey, but turkey can’t hurt patients. The bacteria on the sleeves of a white coat, the appearance of a misunderstood Hippocratic oath in courtrooms, and overdiagnosis from a suboptimal physical examination can all hurt patients. They don’t need to be thrown away, but they must be understood. They need to be studied.

We need to deliberately evaluate traditions because they matter. White coats affect patient perceptions of trustworthiness and professionalism. Nearly 90% of physicians report that oaths have at least some influence on their medical practice. Therefore, it is important that we get medical traditions right. If physicians prescribed medication as often as they use medical traditions, while knowing as little about the medication as they do about medical traditions, it would be malpractice.

A heavy bias toward the status quo has protected medical traditions for too long. It is time to ask why. Ask if you’re doing something because it is the best way, or because that’s how you’ve always done it. Ask whether your white coat is worth the risk of infection, what ethical principles you should swear to, and what the accuracy is of that stethoscope you carry. Above all, ask how these daily rituals are affecting patients.

Brian Elliott, MD, is an internal medicine chief resident.

This post appeared on KevinMD.

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