I have always maintained that the clinical protocols that I recommend for patients will be based on standard teaching on text books, and evidence-based articles in journals. I have always welcomed academic discussion on any point where another person thought otherwise, and if any evidence would be produced contrary to my belief, I would change my opinion and adopt a new policy. After all, it is all for the patients’ sake, and personal ego satisfaction has no place in it.
I think I have failed on two fronts while dealing with a few of my subordinates. On one hand I have not been able to convince them that my approach would be scientifically correct, despite the effort I put in to collect information, analyze it, and present it. On the other hand I have failed to inspire confidence in them that I would welcome any adult-adult discussion with them. It is not that they tried and found that I discouraged discussions. Some of them never tried. Those others who did found that I presented logical arguments which beat their emotional arguments. Perhaps they find it easier to criticize my scientific approach and ridicule it in my absence. Perhaps it assures them that they are better than me and satisfies their ego.
Luckily such people are few. I recall one of our policies of assessing clinically the pelvic adequacy of all nulliparous women and all women with previous cesarean section at 37 weeks or later. My logic was that if the pelvis was inadequate, one could perform a cesarean section electively, rather than allow the woman to be in labor for a variable interval before a decision is made to perform a cesarean section. The senior staff members are home in the evening and night hours unless called for a serious patient. Thus the pelvic assessment would be left to junior doctors and there was a greater possibility of error than if it was performed electively in the antenatal period. Unfortunately one day a person not previous trained by me was promoted and came to my unit in a senior faculty position. She did not choose to hold an adult-adult dialogue with me. But one day another staff member came to see me and said,
“Sir, your junior colleague was heard saying that you have such a ridiculous policy of assessing pelvis at 37 weeks in a nulliparous woman. How can the pelvic capacity be assessed accurately at 37 weeks? Does the fetus not continue to grow after that time?”
I was hurt partly because this junior doctor had chosen to ridicule me instead of discussing the issue in a mature fashion, and partly because at such a senior position she did not know that pelvic capacity is absolute and remains constant, whether the fetus grows or not. For an average sized baby, a pelvis found to be adequate clinically would be adequate during labor. Fetopelvic disproportion would always be assessed during labor. The idea behind my clinical pelvimetry was not to stamp some pelvises as absolutely adequate for labor, but to find those which were inadequate. I would have explained all this to her if she had just asked. Years later I read Stephen Covey and understood that I should not have got upset being people-centered, but should have been principle-centered and should have continued to use my protocol because it was the right protocol. In the meantime I did talk to her and explain my stand, partly to get her cooperation rather than force a policy on her, and partly to prevent her from educating her students wrongly, or they would believe the protocol was wrong and had to be followed only because it was the boss’ whim. After all, her wrong concepts must have stemmed from her teachers’ teachings, since she could not have picked them up from a text book, unless that text book was also written by those teachers. She had to be stopped from doing the same to future generations of students.
