The Upside of Rejection

H. Jack West, MD,


May 31, 2023

A few weeks ago, a friend confided that she was beginning to take it personally that a manuscript covering one of her projects had been rejected by a few journals. I reassured her that I remained confident that the paper would find a home in a journal but also conveyed that there can be value in rejection, at least when accompanied by a reasonable amount of success.

When one of my own manuscripts followed the same pattern of serial rejections just a few weeks later, I can't say I relished the feeling. But it also made me realize that physicians don't talk enough about failure. Specifically, when we don't acknowledge that failure and rejection are inevitable, especially given the impossibly high standards we often set for ourselves. I'd even argue that a fear of rejection can keep us from growing personally and professionally.

It makes sense that, as physicians, we would be conditioned to feel that rejection is to be avoided at all costs. It's also easy to feel like that many of our physician colleagues have only known wild success. Social media platforms often only amplify that feeling. I try to remind colleagues who are just starting on social media, and myself, not to compare your insides to other people's outsides. What you see on social media is the curated version of reality; it's the reality people want to present to the world. Few people share their disappointments and failures. It's no wonder that engaging on social media carries a risk not only for FOMO but for depression and suicide as well.

Although people are far more likely to share their accolades than their miscues, most people's lives are punctuated by a steady diet of both. I believe that there is no best doctor for every patient — medicine is a service industry after all — and doctors will likely encounter negative patient reviews through Press-Ganey scores or on Google and Yelp. Some negative reviews may be predicated on factors outside a physician's control, such as staff friendliness or wait time, and occasionally, physicians may find themselves at odds with patients who make unreasonable demands or are abusive to staff.

But can something positive come from something seemingly negative?

I would say yes. The first positive is the ability to cope with disappointment and build resilience. A tremendous winning streak is nice, but it can also set up escalating pressure or an unrealistic expectation to never fail. Developing a thick enough skin to know that you can't win 'em all is a way to manage expectations and deal with disappointment when it does happen.

There is also value in learning that your interpretation or way of doing things isn't the only or best way. Practicing guitar at home, I can run through songs and feel satisfied that I'm mastering them; but, doing the same thing in front of an instructor has often illustrated that I have glossed over my shortcomings and still have a lot to learn. And though ignorance may be bliss, it won't help overcome deficits, blind spots, or biases. We need to be open to the possibility that our interpretation isn't the only way. We will never improve if we presume that we can't do it any better.

Overall, I think it's important to put negative feedback, whether criticisms raised in a manuscript or a negative review from a patient, into context. Is it fair? As the saying goes, "If you run into an a**hole in the morning, you ran into an a**hole. if you run into a**holes all day, you're the a**hole." A stray negative comment among many gushing reviews may well be an outlier but, instead of simply rejecting it, we should be open to the possibility that the points raised may be valid.

By battle testing our ideas and shoring up our weaker arguments, the sometimes-harsh peer review process makes our work better and more highly cited. When the manuscript gets rejected multiple times, especially with the same criticisms echoed repeatedly, it's probably time to conclude that there is something to them. In the clinic, a pattern of critical comments raising a common theme may highlight a legitimate shortcoming that needs addressing.

In general, not hitting it out of the park every time is okay. In fact, if you're never failing, you're probably aiming too low. My ego needs to be strong enough to sometimes stretch beyond my comfort zone and know rejection will probably come and may even make me better. And despite the filtered view we tend to present to others in our professional lives and on social media, I think it's time to normalize rejection and use it as an opportunity for growth.

As always, I welcome your comments even, and perhaps especially, if they're critical. I appreciate the feedback.

H. Jack West, MD, is an associate professor at City of Hope Comprehensive Cancer Center in Duarte, California, and vice president of network strategy at AccessHope in Los Angeles. West serves as web editor for JAMA Oncology, edits and writes several sections on lung cancer for UpToDate, and leads a wide range of continuing medical education and other educational programs.

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