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How 9/11 thinking can impair doctors' clinical judgment

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7393.829 (Published 12 April 2003) Cite this as: BMJ 2003;326:829
  1. Ralph Crawshaw, retired psychiatrist
  1. Portland, Oregon, United States

    In preparing an address to the Western Institutional Review Board on the climate of medical morality in the north western United States, an unusual psychological phenomenon surfaced—9/11 thinking. The apparent prevalence of 9/11 thinking and its effect on clinical judgment merits wide consideration.

    In preparatory talks with medical colleagues I discovered that American doctors' thinking has changed. Asking, “How do you feel?” usually elicited the answer “Fine.” Only when I repeated the answer back to them—“Fine?”—did speakers pause to think.

    Subsequent responses were not what I might have expected. “Now that you ask, I do not feel fine. I feel anxious.” “I am angry and confused.” “I do not know what to feel about this war.” A visiting Canadian doctor said, “There is an elephant in the room and US doctors do not talk about it. If I say anything, I fear being misinterpreted.”

    Have current events altered doctors' capacity to reflect?

    As strong emotions surfaced, colleagues were understandably cautious. Only as they …

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