The Hawthorne Effect refers to altering an experimental outcome by virtue of studying that outcome. The quest for self-knowledge obeys the Hawthorne Effect. By virtue of the introspection that achieves the insight into self, we change ourselves and, ironically, no longer accurately know who we are. But isn’t being nonjudgmental all about self-insight? How can one be nonjudgmental unless one can recognize his or her own biases?
Each of us has made choices in life: Choices about religion or no religion; choices about where we live; choices about a partner; choices about education; choices about material, such as cars, clothes, books, television shows and toothpaste. Each choice reveals our own preferences. But because each of us has preferences, we cannot be neutral. Truly balanced advice is an ideal—not a reality. While we listen empathetically to our patients as they participate in the joint decision-making process, we delude ourselves if we fail to recognize how our own biases affect our advice.
When Elaine was pregnant, I could estimate for her the chance that the fetus would not survive the pregnancy or her own chances of survival. That was my judgment. I could recommend a medication for an indication not approved by the FDA. That was another judgment. But could I really know the happiness that she would derive from experiencing motherhood again? In the end, my advice became judgmental.
“To thine own self be true,” is a marvelous example of enduring advice. It is uttered by Polonius as he counsels his son in Hamlet. Despite the wisdom that he captures in six pithy words, Polonius is himself a bit of a buffoon, a “tedious old fool,” in Hamlet’s words. How ingenious of Shakespeare to coin an aphorism that has been remembered for centuries by placing these words in the mouth of an errant father.
As rheumatologists, we are like Polonius, glibly dispensing advice. Shared decision making is an admirable ideal, but we deceive ourselves if we believe that we achieve it.
James T. Rosenbaum, MD, is professor of ophthalmology, medicine and cell biology at Oregon Health & Science University in Portland, Ore., and chief of ophthalmology at Legacy Devers Eye Institute, also in Portland.