Views & Reviews Personal View

Physician, humble thyself

BMJ 2009; 339 doi: (Published 14 October 2009) Cite this as: BMJ 2009;339:b4218
  1. Erica Frank, professor, Department of Health Care and Epidemiology and Department of Family Practice, University of British Columbia, Vancouver
  1. efrank{at}

    Two examples of doctors’ sense of entitlement still bother me. The first was at an American Medical Association meeting, while I was riding in a cab with several colleagues to dinner after a long day of meetings. My colleagues were complaining, as they often did, about their working conditions and pay, feeling underappreciated and undercompensated, like many American doctors seem to. About 10 minutes into the drive I asked them, “How do you feel about complaining like this in front of a taxi driver?” The question produced an awkward silence. The cabbie was no longer invisible to them, and how he might hear my friends’ concerns, given his view of his own job, was uncomfortably obvious.

    The second example was with a then close friend of mine, a fellow physician at a large hospital with many patients from poor backgrounds. My friend had come from a financially comfortable family, had received the world’s finest medical training, and was smart, competent, and pretty. She had everything going for her.

    The two of us were chatting, as we often did, about work. And in the midst of our complaints I thought of how grateful I’d been in the morning as I went through a toll booth on the way to clinic. I thought about how glad I was not to be a toll collector and how unpleasant that job would seem to me: breathing bad air; having consistently superficial and instantaneous—and often thankless or negative—interactions with people; having no control over what I did, in a job that likely could be done as well by a machine, with few opportunities for advancement; supporting a car culture; doing nothing obvious to improve the world; and getting paid poorly. I thought it would be deeply unsatisfying work, and I was grateful for the opportunity I had to get relatively very well paid for a job that was usually interesting, fun, safe, and world improving.

    When I told my friend my reflections on the toll taker, she looked at me and said, “You don’t understand. That person isn’t even in my class.” She actually used the C word, and I was astonished. I knew that my friend had spent most of her career treating the underserved, often with personal sacrifice, and devotedly training others to do so. She did so with compassion and seriousness, and this was hard to reconcile with her comment, hard to believe that she believed that a near neighbour’s options were irrelevant to hers.

    So what might we make of this apparent sense of entitlement? Is it uniquely North American? Perhaps it is caused by the near universal expressions of beleaguerment that I hear from North Americans, the sense of being overly busy. Schopenhauer said, “What makes people hard hearted is this, that each man has, or fancies he has, as much as he can bear in his own troubles.” Or perhaps there’s some other reason that the founder of the Sermo website for doctors ( would entitle a July 2009 article “Why physicians always get screwed.”

    No matter what the cause, the phenomenon of entitlement even seems to extend to our expectations of wellbeing. Despite the fact that doctors can expect to have a longer than average life (American Journal of Preventive Medicine 2000;19:155-9, doi:10.1016/S0749-3797(00)00201-4) and have stimulating and rewarding jobs, they still seem to have a “woe are we” attitude, that we just don’t have it good enough. We often feel entitled to be respected, accommodated, and fulfilled throughout our lives because we have worked so hard and are so deserving. These conditions are fundamental human aspirations, and doctors may be at least as deserving of them as nearly any other group, but do we really deserve that much more than someone working two thankless, dull jobs to make a modest living for their families? I think a bit more of a realisation that “there but for the Fates go I” would serve us all well.


    Cite this as: BMJ 2009;339:b4218

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