Doctors who feel ground down can renew their spirits and their values

See also p 1633

Why do so many physicians wallow in woe? Why do so few resist imposed yet ill advised policies, regulations, and practices? Why is there reluctance to band together with each other and patients to make suggestions and take action? Physicians list several reasons. Some find that the pleasures of the practice of medicine outweigh the problems, so they choose to disregard the problems. Others report that clinical ambiguities can lead to professional paralysis. A recent issue of the BMJ, for example, highlighted the shortcomings of available science: we do not know how to prevent deaths caused by mentally ill people,1 the best surgeons to operate on patients with pituitary tumours,2 or the explanation of chronic pelvic pain in men.3 Minerva reported the difficulty of performing much vaunted meta-analyses.4 Since uncertainties far outnumber certainties in science, medicine, and life, slow brownian motion—keeping a low profile—seems less upsetting and risky than thrusting forward.

Other reasons given for moaning instead of moving ahead include: “We were brainwashed during training,” “Authorities don't respond, so why bother?” “Our …