How to bake a palatable humble pie

By Dr Rachele Quested, Deputy Co-Chair, Committee of Doctors in Training

Ingredients: one doctor in training, several consultants of different flavours, a multi-disciplinary team and an excessive workload
Method: mix everything together, shake over a disjointed fatigue-inducing roster and bake for 5-8 years. 
Test regularly.

Apparently, the expression humble pie derives from umble pie – made from the entrails of a deer. As the English are prone to dropping their Hs these words became intertwined and at some point in time a new cliché was born. Perhaps another one to lay at the feet of Charles Dickens – Uriah Deep in David Copperfield “ate umble pie with an appetite”. Even more interestingly the world umble comes from numble which is a French word from the Latin lumbulus meaning a little loin - a short jump from there to lumbar (spine!).  

I’d thought I’d had my share of humble pie over the years but, nothing compares to medical training. It is likely many medical folks are similar – many of us have expected ourselves to excel at school and other avenues in life. Medical training programs add a new element of uncertainty and difficulty that can be really unsettling. Australia-wide, the rate of a complete pass in fellowship exams varies from college to college but can be as low as 30 per cent. Let me repeat that number – 30 per cent! This is pitting the very small number of doctors who have spent at least five years of their life working in a specialised part of medicine against a piece of paper and a few examiners and only 30 per cent are perceived to be good enough. Training pathways help you along the way with coping with this type of failure. Failure is in fact a good part of how we learn. How can we own this and not be weighed down by it? 

Medical failure is not like other failures. When we fail, we might miss a diagnosis that costs someone time, we might prescribe a medication that causes a reaction, we might perform an operation or a resuscitation that does not go as intended. These failures impact other people. These failures are also failures that everyone in the room with you has been through. Every senior doctor you look up to has been there - even the ones who don’t talk about it to you. Some of the best presentations I have been to have included doctors relaying their mistakes. Occasionally this may help prevent someone else from repeating them but, in my experience, somehow, I feel I am doomed to repeat every one of them anyway. I have had to learn to change how I view myself – accepting failure as part of my everyday experience and not allowing that to impact on my perceived value as a human being. Feedback in all forms is gold – how it is delivered will determine the change it may elicit in the person receiving it. 

Here is another thought – the more you learn the less you know; as we pass down our specialist trails the rabbit hole gets deeper, more angled and the way home is less and less clear. Our minds are changed and shaped by this experience – the rare becomes common, the zebra replaces the horse every time. Then, apparently, we have to flip this backwards and find our way back out again – to deal with the mundane but able to recognise the zebra when it rears its unusual head again. Does this then mean we are ready to be in charge? 

With some excellent ice-cream, Humble Pie can be a palatable offering at the table – it will be offered to you many times over the coming years and learning how to accept, nay, enjoy the taste. It is not just self-flagellation, it is creating the humble and experienced doctor that you are striving to become.