“Doctors are human animals. They want to be loved, they are tribal, they instinctually favor stories over scientific evidence, they make mistakes, and even small gifts make them susceptible to being biased. If we took doctors seriously as human animals, we might hurt them — and they might hurt us – a lot less.” — Alice Dreger
I have a passion for sailing that I inherited from my father. Beyond my love of medicine as a profession, nothing defines me more, classifies my tribe better, than sailing. It is my escape, my solace, my reward for a successful career. This past weekend was spent with my sailing companion and wife, Pam, exploring the Chesapeake Bay. We have been sailing these waters for over a decade but continue to find new waterways to navigate and anchorages to explore.
The three-day cruise was delightful and was capped with a perfect 10- to 15-knot breeze that saw us close hauled passing under the Chesapeake Bay Bridge headed for home at 8 to 9 knots boat speed — nirvana. The only detraction from an otherwise spectacular weekend sail was the other Bay tribe — powerboaters.
I am not speaking of the small, outboard fishing boats. The powerboats I loathe are the massive, fuel-guzzling, smoking, monstrosities that ply the Bay, cutting high-speed furrows through the water and leaving behind huge wakes. From my sailing tribal perspective, these powerboats serve no purpose beyond indelicately cleaving the waters from destination to destination while devilishly maneuvering to pass as close to sailing vessels as possible for the joy of watching the hapless sailboats bounce and crash in their wakes.
The rational portion of my intellect recognizes that my belief that powerboaters ply the Bay with the sole diabolical purpose to destroy my boat speed and manically laugh as I bounce in their wakes represents the epitome of personal hubris on my part. In reality, the powerboats hardly notice sailboats beyond the irritation these slow, lumbering vessels epitomize by forcing powerboats to deviate from what would otherwise have been a satisfying straight-line course to their destination. Sailing, I imagine, is as much of an anathema to the tribe of powerboaters, as “stink-pots” (my father’s label for powerboats) are for sailors.
Powerboating and sailing attract people to boating for different reasons, but these seemingly unique tribes do have something in common — a love of boating and the water. As a sailor, I may never understand or appreciate the attraction of powerboating, but I can commiserate with the joy of being on the water and successfully navigating a vessel through the sea. Although it is difficult at times to recognize powerboaters as kindred spirits while smashing through the wake of a powerboat that has passed far too close, fact is they are lovers of the Bay, just like me. They merely express their passion differently, while burning far more fossil fuel.
As I was sailing this past weekend lamenting the preponderance of powerboaters, I began to think about how similar medical tribal culture is to boating tribes. Like boating, medical professionals are attracted to different aspects of medicine for reasons that are as varied as the individuals entering the field. Like sailors and powerboaters, medical professionals tend to identify with their particular flavor of medical practice, their tribe and are inclined to have little patience or understanding for other areas of medicine or practitioners different from themselves. As my irrational distain for powerboaters does not enhance my time sailing, the tribal divisions or silos of medicine do not necessarily improve on our ability to care for patients.
There is something deep within human evolutionary biology that causes us to form tribes and derive comfort in groups with similar points of view to our own. When human existence consisted of little more than finding food, avoiding becoming food and raising children, there was a significant advantage to survival in being a member of a tribe. Even in modern society, there likely still are significant social benefits to being part of a group that shares similar values or goals. Unfortunately, tribal approaches to social interaction can result in real inertia to progress as our technology and capability increases the need for flexibility in thought. Perhaps this is nowhere more apparent than in the field of medicine.
Beyond medical tribal barriers among the various medical specialties, tribes of thought often develop and fragment the activities within individual medical concentrations. Although examples of medical specialty tribes abound, my own field of pain medicine is certainly a prime example. The mistrust and general disdain between the pain interventional and integrative communities is pervasive. The failure of these pain tribes to see beyond their own spheres of influence and recognize the value of other pain-management approaches or other tribes, has certainly hindered the advancement of pain medicine. Certainly pain patients have not benefited from the irrational fragmentation of pain medicine services.
Doctors, and I am as guilty as the next, tend to fail to recognize they are human and susceptible to petty, tribal beliefs that bias their actions with patients in directions not supported by evidence. In military medicine, this situation is made worse by the tribal nature of the three services.
As medical professionals, we need to be sensitive to the dangers of tribalism in medicine and work to develop an appreciation and understanding of medical approaches different from our own. As a boater, recognizing the value of other boaters will enhance my time on the water. As a medical professional, recognizing the value of other medical professionals will enhance the medical experience of my patients. Medical leaders are those unique individuals able to see beyond their own tribal bias and coordinate the various medical approaches dispassionately with their focus on the needs of the patient rather than the needs of their particular tribe. Imagine what could happen if everyone in federal medicine took some time to look beyond their particular tribe to view the larger medical perspective. How could our patients not benefit from such an approach?