Close Rank

“They probably had good reasons…”
“Most likely they thought that…”
“Based on the statistics…”

I wanted to talk a bit about something I have experienced as a patient and encountered in conversations with peers; the tendency to become apologists for the medical system at the first sign of criticism. 

The training to become a doctor is not easy and the career difficult, so I understand the desire to defend what we have worked hard to become and the system we work in. I have seen residents invalidate patient’s negative experiences, rationalizing away their issues to make them fit proper care. In a recent conversation with peers the mistreatment of an Aboriginal patient in an ER was explained away citing statistics of drug/alcohol use and justifying why he was so poorly treated. This tendency is one I think we should be aware of in our contact with patients as it can severely damage the physician-patient relationship. Closing rank and defending the system invalidates their experiences, increases frustration/anger and places a major barrier in the way of building a relationship and open communication. 

I know such reactions are difficult to avoid, especially when you feel attacked. It is hard to overcome the natural tendency to defend oneself and field. However, rather than jump to the defense of the system, trying to understand what the patient experienced and the reasons behind their poor experience goes a long way in rebuilding trust and fostering a productive relationship. Furthermore, being open to criticism and trying to see its root causes, you may discover ways to improve the healthcare system or the care you give.

- Kevin D. (UWO)

[Editor's Note] If you'd like to read more of Kevin's writing, please visit his blog at