Why do we hesitate to tell the truth in medicine?  I think about this frequently.  Why do we diagnose pseudo-syndromes?  Why do we dance around the problems patients cause for themselves? Why do we ignore the ridiculous things physicians do?

I think, in our post-modern world, we fear being judgmental.  To be characterized as ‘judgmental’ may be the most terrifying epithet of all.  For we are told it implies that one has access to unique knowledge, or that one’s own opinion is somehow superior.  ‘Who am I to judge?’  We say it with regularity, and we say it to absolve ourselves from hard decisions.
But we don’t need to fear it.  We need to use, not the pejorative term judgmental, but the accurate term ‘discerning,’ when we look at our colleagues and patients.  It is not judgmental to suggest changes in behavior, like exercise, weight loss or decreased alcohol use.  Nor is it judgmental to suggest that physicians use caution in their sexual activities, or that they shun illegal drugs.  Those things are part and parcel of the discernment people come to us to receive.  They need our honest assessments, our guidance.  They don’t need our tacit acceptance of every behavior, or every habit, in order to ease their minds of guilt, or deliver them from responsibility.

And our culture, our nation, our youth need for someone to stand up and say, loudly and in annoying voice, ‘For heaven’s sake, people, grow up and take responsibility for your lives!’  That’s not judging…that’s guiding.

So the next time someone says you’re judgmental, say ‘no, I’m not.  I’m just discerning.  And in my discernment, you are wrong!’

If nothing else, it will confuse them.

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