• Skip to main content
  • Skip to primary sidebar
  • Skip to footer

33 Charts

  • About
    • What is 33 Charts?
    • Bryan Vartabedian MD
  • Blog
  • 33mail
  • Foci
    • Social/Public Media
    • Physicians
    • Patients
    • Hospitals
    • Information
    • Process/Flow
    • Technology
    • Digital culture
    • Future Medicine
  • The Public Physician
Featured, Physicians

Doctors and the Endemic Culture of Permission

July 13, 2013 By Bryan Vartabedian · Reading Time: 2 minutes

Recently Richard Smith, editor of the BMJ, called out the NEJM for failing to publish critical letters. His post in the BMJ blog network calls out NEJM as elitist. If electronic space is unlimited, he asks, why limit letters?

Good point. Buy why assume that conversation is controlled by the NEJM?

This is a great illustration of what I have come to call medicine’s culture of permission.

As physicians we’ve been raised to seek approval before approaching the microphone.  For the hundreds of years you could only say something if someone gave you permission.  It used to be that the only place we could share ideas was in a medical journal or from the podium of a national meeting.  Our ideas were were required to pass through someone’s filter.

The angry scientists cited by Smith are of a generation when someone else decided if their ideas were worthy of discussion.  They are a generation trained to contain what they think and believe.  They are the medical generation of information isolation.  Our culture of permission has bred a generation of obsequious followers.

In Poke the Box, Seth Godin calls this the tyranny of the picked:  Waiting and hoping “acknowledges the power of the system and passes responsibility to someone else to initiate.”

This is unfortunate.  When I think about my peers, I think about the remarkable mindshare that exists.  Each is unique and brilliant in the way they think and see the world.  Each sees disease and the human condition differently.  They carry stories and experiences that can ease minds and save lives.  But their brilliance and wisdom is stored away deep inside.  They are human silos of unique experience and perspective.

But the way the world communicates and creates ideas is changing.  The barrier to publish is effectively non-existent.  The democratization of media has given every physician and scientist a platform to the world.  But somehow we still believe that NEJM is running the show.

Going forward, the conversion of medical information into knowledge and knowledge into wisdom can only happen in a culture of participation.  In the emerging networked world, we are all individuals endowed with unique skills, abilities and gifts.  The unique mindsets and views that define us will allow us to offer something that was never before available.

The assumption here is that the only place for dialog and publication is within the boundaries of a paywall-controlled platform.  This ignores the way the world communicates and shares information.

The problem here is not the antiquated ways of the NEJM, but the dated, permission-based thinking of the medical public.

If you like this you might like the 33 charts culture of permission Archives. It’s everything written here about this subject.

Related Articles

  • Beware Invisible Doctors
  • Cureus Redefines Medical Publishing
  • Regulating How Doctors Behave

Tagged With: Culture of Permission

Related Articles

  • Beware Invisible Doctors
  • Cureus Redefines Medical Publishing
  • Regulating How Doctors Behave

Primary Sidebar

Bryan Vartabedian, MD

Bryan Vartabedian, MD
Bryan Vartabedian is the Chief Medical Officer at Texas Children’s Hospital Austin and one of health care’s influential
voices on technology & medicine.
Learn More

Popular Articles

  • The Fate of Fired Cleveland Clinic Resident Lara Kollab

  • 12 Things About Doximity You Probably Didn’t Know

  • Cures Act Final Rule – How It Will Change Medicine

  • Should Physicians Give Their Cell Phone Number to Patients?

  • Doximity Dialer Video – Telemedicine’s Latest Power Player

Sign up for 33mail newsletter

Featured Articles

Reactive and Creative Spaces

Yes, Doctor

Doctors and social media: Damned if you engage, damned if you don’t

Context Collapse and the Public Physician

Will the Future Need Doctors?

  • Facebook
  • LinkedIn
  • Twitter

Footer

What is 33 Charts?

With a mashup of curated and original content that crosses the spaces of digital health, media, communication, technology, patient experience, digital culture, and the humanities, 33 charts offers unique insight and analysis on the changing face of medicine.

Founded in 2009 as a center of community and thought leadership for the issues doctors face in a digital world, 33 charts was included in the National Library of Medicine permanent web archive in 2014.
Learn More

Foci

  • Digital culture
  • Digital Health
  • EHR/Health IT
  • Future Medicine
  • Hospitals
  • Information
  • Patients
  • Physicians
  • Process/Flow
  • Quality
  • Social/Public Media
  • Technology

Copyright © 2025 · 33 Charts · Privacy Policy