COMMENTARY

Should Doctors Act Confident Even When They're Not?

Arthur L. Caplan, PhD

Disclosures

October 01, 2018

I'm Arthur Caplan, director of the division of medical ethics at the NYU School of Medicine.

When I present these kinds of opinion pieces, one thing I think about is the need to project confidence, trying to make sure that I come across as knowing what I'm talking about. That is something people who give video opinions or presentations are taught is important. You want to sell your message. You want people to think, "He's an authority," "She's a reliable source," "That's someone I should listen to." You don't have to agree [with your audience], but you want to be taken seriously.

A recent article[1] in Annals of Internal Medicine described a related scenario. A female medical student wrote that while on rounds, she was upbraided for presenting accurate, truthful, and comprehensive information, albeit not with confidence. She further noted that another female medical student, who didn't seem to have the facts straight and didn't seem to have the information right, was praised—not for being in error, but because of the confidence she exhibited in her presentation.

This raises a very interesting issue. Do we encourage confidence in patients and other audiences by a single style of presentation? Or do we need to think a lot harder about what manner or behavior makes for presentations that instill confidence?

We all understand that the message in medicine has to be more than just projecting confidence, whether when talking to a patient, giving a presentation at a meeting, or trying to explain the nature of a disorder or disease to someone. Sure, we all want our doctor to be someone who has confidence in his or her skills and abilities, and can project that to make us feel a bit more at ease when we're facing risky surgery, dangerous drugs, or even crises that could end our lives. Few of us would want a doctor in whom we didn't have confidence.

But where should we draw the line around demanding confidence? I don't believe that confidence should be a cover for ignorance. Too often in our society, we see politicians and others claiming to be experts; we see people pushing alternative medicine, and even quackery, with great confidence, saying that this, that, and the other thing is true or will help or is a good thing. We don't want to confuse confidence for competence.

I also don't believe that this is a male-female issue. It may involve different styles of presentation. A person can still have confidence that someone who is quieter or not aggressive knows what they're doing.

What we need to do is agree that while we want to make sure that our students learn to project a manner that instills confidence in a patient—or if they're speaking to various groups, confidence in the audience—there is not only one way to do it. Confidence doesn't have to be expressed in the traditional male, assertive, outgoing way. And it is possible to admit uncertainty or [to say] "I don't know; I'm not sure what the answer is" as part of a confident presentation about a particular topic.

After all, if you're talking about something, you don't want to miss information or not get data back that could fill in a missing and important piece of the puzzle because the patient figures you're so confident that you must understand everything. That would be an error too.

For me, confidence is not male or female. It's not only one style. We need to talk more about different styles that work, perhaps studying them a bit more to come to understand that. But I can say, with a lot of confidence, that it isn't something that should be dividing male and female physicians. We can role-model confidence with many different types of behavior.

I'm Art Caplan, at the NYU School of Medicine. Thanks for watching.

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