As I look back at my career, two professors stand out. They affirmed me when I did something well (in words I wrote in my journal, would go back to and read when I was discouraged). They recognized my weaknesses but did not concentrate on them, although they did not ignore them either. Both made me think I had the stuff to be a cardiologist. I flourished; I am where I am today, in part because of them.

But I vividly remember two other professors. After looking at a first draft of a manuscript, one research mentor told me, “This is terrible. Why am I wasting my time reading it?” And an attending who oversaw my training in cardiac catheterization once told me, as we reviewed films after a cardiac catheterization, “Can’t you see that tight LAD lesion, you idiot! You missed the widow maker.”

Now when I am in the cath lab, I look at the angiogram a second and a third time. I want to be sure I’m not missing a severely narrowed coronary artery. But I also review it so carefully because of the fear of God that attending instilled in me. One side of me says I would do catheterizations just as thoroughly had Doctor Nice Guy been the one who taught me. But there is another side that is not so sure. And I’ve written my share of research papers. As I worked on them, I was sometimes inspired by an imaginary senior author peeking over one shoulder, telling me, “Wow, great start.” But just as often, I set my standard high because I also sense that former mentor peering over the other shoulder, screaming, “This is terrible!”

Harsh criticism is hard to take. It makes me question my abilities. After being berated at work, I used to ponder, “Do I have what it takes to be a doctor? Should I give up and go back to the Midwest and farm the old home place?” But taking care of patients is different than farming. Medicine is life and death. I won’t kill someone if I choose the wrong seed corn for the swampy back 40, or if I don’t harvest the wheat before the hailstorm. But I might if I forgot to check the potassium after I start a patient on a strong diuretic. “You idiot! What were you thinking! You let this woman’s potassium drop to 2.5. She could have died!” is a strong impetus to help me remember. Sometimes it works better than, “Try to remember next time to get labs more often.”

It’s easy to think persons criticizing me harshly mean it personally. But I think that rarely is the case. Perhaps they were treated that way themselves. Or, maybe back when they were a resident, they missed a subtle change on an ECG and a patient coded. They don’t want me to make that mistake, and their harsh criticism is their way of making that point most effectively, they think.

When I get enough sleep and drink an espresso before work, it’s easy to care for patients empathetically. But that’s not so easy at the end of a brutal day when there are two more patients to be seen, and it’s already 7 p.m. At that hour, I recall a resident telling me, 36 sleepless hours into a shift, “You pathetic wimp, what’s wrong with you? Just do it!” It’s a strong motivation for me to take good care of those last two patients.

I think about my own mistakes when I round on the wards. Sometimes I wonder if I am too nice to the resident who overslept and didn’t have time to listen to a patient’s lungs. Perhaps some yelling might help him remember. Maybe not yelling, but some words, spoken in a manner that will ring in his ears when his alarm goes off tomorrow morning, and he’s tempted to hit the snooze button.

There’s been a change in the way attendings critique those under them. Residents are rarely told they are idiots, that what they have done is “terrible.” That is good, and we shouldn’t shift back to the old way of doing things. But there may be times when strong words are needed. I’ve needed both the affirming professors and the professors who said harsh things. I thrive on “You can do anything you want to do.” But there are times when “This is terrible!” is exactly what I need to hear. I wish it wasn’t that way, but it is.

Details have been modified to maintain anonymity.

Joseph Gascho is a semi-retired professor of medicine and humanities. He can be reached at Gascho Word and Image.

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