By Vinay Bhardwaj, MD
Medicine moves forward not just on the back of discovery but also through the willingness to challenge what came before. Yet, much of medical education and practice is still haunted by “shibboleths” — beliefs, customs, and protocols passed down from teacher to student without ever being questioned.
These shibboleths often take the form of familiar phrases: “This is just how it’s done,” or “We’ve always known it works.” They’re repeated so often that they’re rarely challenged. The problem is that unquestioned knowledge, no matter how well-intentioned, can lead to error, misdiagnosis, or worse—harm to the very patients we aim to heal.
What is a Shibboleth?
In ancient times, a shibboleth was a linguistic marker—a word or phrase that separated insiders from outsiders. Today, it describes any entrenched belief, method, or saying that persists without scrutiny. Medicine is rife with shibboleths, not because doctors are unwilling to think critically, but because the pressure to keep pace with a fast-moving field often makes it easier to follow tradition than to question it.
Shibboleths offer the comfort of certainty, but in a field as dynamic as medicine, certainty is dangerous. When physicians rely on convention instead of inquiry, we risk turning treatment into dogma—and dogma into harm.
Examples of Dangerous Shibboleths in Medical History
The Overuse of Bloodletting
For centuries, bloodletting was the go-to treatment for everything from fevers to mental illness. The practice persisted for nearly 2,000 years, bolstered by physicians and scholars who claimed it restored balance to the body’s humors. It wasn’t until the 19th century, after mounting evidence of harm, that bloodletting finally fell out of favor. By then, countless patients had suffered. The tragedy here isn’t just that bloodletting didn’t work—it’s that doctors repeated the treatment without ever asking whether it should work.
H. pylori and Peptic Ulcers
For decades, the medical community believed that stress and lifestyle factors caused peptic ulcers. It was only in the 1980s that two Australian scientists, Barry Marshall and Robin Warren, discovered that the bacterium Helicobacter pylori was the real culprit. Their findings were initially dismissed—Marshall famously drank a petri dish of H. pylori to prove his point. This discovery revolutionized the treatment of ulcers, but it also revealed the stubborn resistance to new knowledge when it threatens established beliefs.
The Opioid Crisis and “Pain as the Fifth Vital Sign”
In the 1990s, the introduction of “pain as the fifth vital sign” created a new paradigm: undertreated pain was seen as a marker of poor care, and opioids were marketed as safe and effective solutions. Many doctors embraced these practices because they aligned with the then-accepted belief that opioids carried little risk of addiction. We now know how catastrophically wrong that belief was, but at the time, the momentum of a shibboleth—unchecked and widespread—drove clinical decisions.
How to Be a Skeptical, Independent-Minded Physician
It’s easy to think that we’ve outgrown the need to question convention, but the truth is that modern medicine still carries many shibboleths. From unnecessary diagnostic testing to reliance on outdated guidelines, these relics persist in ways both subtle and obvious. So, how can physicians guard against them while maintaining an open but discerning mind?
1. Develop a Habit of Questioning Your Own Assumptions
Ask yourself: When was the last time I truly reconsidered one of my core clinical beliefs? Medicine evolves rapidly—what you learned in medical school may no longer be best practice. Make it a point to review recent literature and stay open to findings that challenge your previous understanding.
2. Embrace Discomfort: It’s a Sign You’re Thinking
It’s human nature to resist information that contradicts what we already believe. When new evidence feels uncomfortable, don’t dismiss it—lean into it. Discomfort is often the first sign that you’re engaging with an idea that needs scrutiny.
3. Avoid Confirmation Bias and Seek Dissenting Opinions
Physicians, like everyone else, are prone to confirmation bias—our tendency to favor information that aligns with our pre-existing beliefs. When reviewing research or consulting colleagues, actively seek out dissenting opinions. Learning from those who disagree with you helps refine your thinking and ensures you’re not just reinforcing old patterns.
4. Be Vigilant, but Not Cynical
There’s a fine line between skepticism and cynicism. Skepticism invites inquiry, while cynicism shuts it down. The goal isn’t to reject every guideline or protocol you encounter, but to approach them with healthy curiosity. If the evidence supports a practice, use it. If the evidence is thin or outdated, dig deeper.
5. Build Time for Reflection into Your Practice
Modern medicine is fast-paced, and it’s easy to get caught in a cycle of treating symptoms without stepping back to think critically. Make space for reflection—whether through journaling, discussions with peers, or participation in journal clubs. Reflection allows you to spot patterns of dogma in your own practice and helps you course-correct when needed.
Moving Forward: An Open but Grounded Mindset
Medicine demands a delicate balance: you must keep an open mind without falling prey to quackery. Not every new idea will be correct, and not every old one will be wrong. The key is to remain curious and willing to learn without abandoning the rigor of evidence-based practice. This means neither dismissing unconventional ideas out of hand nor accepting them without scrutiny.
In a sense, being a good doctor means constantly unlearning and relearning. This process is uncomfortable, even exhausting, but it’s also necessary. Medicine isn’t a static field—it’s a dialogue between the past and the present, between what we think we know and what we’re still discovering. The best physicians are those who learn to live in that tension.
In Conclusion: Stay Skeptical, Stay Kind
Shibboleths endure because they offer certainty in a world where certainty is rare. But good medicine isn’t about certainty—it’s about curiosity, humility, and the willingness to say, “I was wrong.” The next time you encounter a well-worn piece of advice, pause before repeating it. Ask: Is this still true? What’s the evidence? Am I helping my patient by following this path—or am I just repeating a shibboleth?
By embracing this mindset, you can avoid the trap of unquestioned knowledge and help ensure that medicine remains a dynamic, thoughtful practice—one that grows and evolves for the betterment of patients. At Ensocure, we believe that the best care comes from doctors who think independently, act compassionately, and challenge the status quo, even when it’s uncomfortable.
Because in the end, medicine should never be about saying a word three times and moving on. It should be about asking the right questions—and having the courage to change when the answers surprise you.
This article is part of Ensocure’s ongoing efforts to foster thoughtful, evidence-based healthcare. We hope it serves as a reminder that the best care doesn’t come from repeating old practices but from rethinking them. Stay curious, stay kind, and never stop asking questions.
