Nowadays we are less punished by feelings of conscience than we used to be, as Mr Alexander McCall Smith has observed, because guilt is slowly disappearing from our lives. On the one hand, that’s a good thing, because guilt can cause enormous unhappiness and has done so in countless circumstances. But on the other hand, guilt provides a kind of moral compass and is a potent disincentive for actions that are wrong. Some of us were raised in circumstances that ensured a feeling of guilt about everything we did, and it has taken me a lot of rationalization over the years to grasp that not all guilty pleasures need be guilty. But still there is the uncomfortable feeling that someone is watching disapprovingly.
I’m going on the BCMJ CME cruise, but my conscience is uneasy about it. I’m feeling guilty because potentially it will be a pleasure-filled event, and CME is supposed to be serious stuff. The purpose of CME, surely, is to make us better at what we do, and we should thus attend events that are reliably going to do so. Yet I fear that we’re all more inclined to attend events that are offset by some indulgent pleasure than events that fulfill a clearly identified professional need. So I’m concerned that my decision to go on this cruise indicates a slide into decadence and self-indulgence, without tangible professional gain.
No, wait! Going on the cruise will be a courageous undertaking, now that I think about it. First, I will have to brave the hazards of air travel, including the stress of confronting both Canadian and US Customs officers. I will be willingly exposing myself to the possibility of contagious disease, including not only Norwalk but also a whole host of other possibilities: Legionnaire’s disease, yellow fever, malaria… There is also the possibility of piracy in the Caribbean, so I’m told, and I doubt that the ship has an on-board militia to repel any armed attack. And what if the ship sinks? Clearly we will be in some danger for the whole week. The Caribbean sun can be ferocious, so I will also have to remember to use sunscreen and wear protective clothing, and I just know it won’t be enough. I anticipate significant pigmentary change, which will undoubtedly affect my self-esteem. I will be forced to eat food according to the ship’s schedule, not my own—whatever happened to self-determination? The hazards of forced alcohol consumption speak for themselves. There will be the financial stress of having to buy souvenirs and provide hospitality. And on top of these hazards, I will be attending CME presentations by colleagues with vastly superior presentation skills, again buffeting my self-esteem.
Help! How could I possibly have decided to do this? How can my colleagues undertake this kind of activity without fear? Forget guilt—there are much greater hazards facing those who attend this CME activity. Spare a thought for the courage of the BCMJ Editorial Board members, who may or may not be back for the March issue.
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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
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