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Donald M. Berwick, MD

JAMA. 1991;266(6):841-842.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Sometimes learning requires courage. It can be difficult for experts, especially, to admit candidly that they could be better at what they do if only they knew more. To become a learner is to become vulnerable.

The vulnerability is greater—and so, therefore, must be the courage—when accusation and fear are widespread. Under the threat of punishment or ridicule, normal people are more likely to defend themselves than to stretch themselves. Why take the risk of voluntarily admitting a need to learn more when that very admission can be used to hurt me?

The dilemma is painful. On the one hand, improvement depends on learning from information about performance. Yet, on the other hand, that same information can easily be used to make and enforce judgments that provoke fear and prevent learning. In many arenas, American culture seems addicted to forms of surveillance, measurement, comparison, . . . [Full Text PDF of this Article]

Author Affiliations
From the Harvard Medical School, Boston, Mass.

Footnotes
Reprint requests to 131 Lake Ave, Newton, MA 02159 (Dr Berwick).

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