The Beacon and the Canvas: Beyond the Pseudo-Profound BS of Academic Medicine

For over two decades, I’ve navigated the labyrinthine halls of some of the world’s most prestigious academic medical centers. Fifteen years in one of the largest healthcare systems in America, spanning renowned medical institutions, followed by over a decade at a leading academic healthcare center in South Asia. These years were filled with purpose, bureaucracy, triumph, and disillusionment in equal measure.

But somewhere along this journey, a quiet restlessness began to grow. A persistent question hovered at the edges of my thoughts: Is this still my north star? I found myself staring down the existential dilemma so many seasoned academics face: whether to stay within the familiar walls of institutional academia or step outside into the untethered expanse of something different.

In a way, this essay feels like a continuation of thoughts I began exploring several years ago in "Sir? No Thank You!", a reflection on institutional inertia, misplaced loyalties, and the uneasy balance between purpose and performance. But time and distance have sharpened those reflections, and this feels less like a farewell and more like a reckoning.

Years ago, in a board meeting, a medical educator colleague presented an innovative medical education pilot project. A trustee commented, “This is great work, but remember: real innovation happens only at the periphery. The moment institutional leaders focus on your innovation, let it go. Step aside and let them take over, because at that point, it becomes bureaucracy.” Over time, especially post-COVID, as interest in digital medical education grew, it became clear what the trustee meant. A power struggle ensued, the work stopped being fun, and my colleague moved on to create new innovations in medical education, leaving others to champion the original initiative.

The above story resonates deeply with my own journey, where clarity came in stages, informed by three pivotal papers from academic journals. Each of which is a beacon challenging me to reframe my understanding of the systems I was part of and my role within them.

Simone’s Maxims: The Compass in the Chaos

A decade ago, a senior departmental chair at the academic center I worked for, handed me a copy of Simone’s Maxims. It wasn’t just another academic paper; it became a bible of sorts. Joseph V. Simone’s blunt yet deeply insightful reflections on academic medicine were like lanterns placed strategically along a dark trail.

One maxim in particular, "Institutions don’t love you back," stayed with me. Early in my career, I poured myself into a project; working long nights, sacrificing weekends - only for it to be quietly shelved after an administrative reshuffle. The institution didn’t owe me closure, nor gratitude. Simone was right: our real connections are not with the institution itself but with the people we work alongside, the patients we serve, and the impact we leave behind.

Another of Simone’s lessons, about the inertia of institutional committees, echoed across continents. Simone warned that "Members of most institutional committees consist of about 30% who will work at it despite other pressures, 20% who are idiots, status seekers, or troublemakers, and the rest a passive audience.” Whether in large academic centers in the US or South Asia, I’ve sat through meetings where bold visions were diluted into vague platitudes. In one such meeting, titled something grandiose like "Strategizing Synergies for Integrated Excellence," I caught myself wondering if we were solving healthcare problems or rehearsing for a corporate TED Talk.

Simone’s maxims were not cynicism; they were clarity. They became tools for discerning when to push forward, when to step aside, and when to walk away entirely. And they echoed the insights of mentors I’ve had; who taught me to stay grounded and resist the pull of institutional spotlight.

The Pervasive Fog of Pseudo-Profound Bullshit

While Simone provided clarity, I couldn’t ignore another phenomenon permeating academic medicine: pseudo-profound bullshit. Gordon Pennycook and colleagues describe it as language that "implies profundity without actually conveying any clear meaning." If Simone was the compass, Pennycook offered me the fog lights.

It became hard to unsee once I recognized it. Strategic vision statements, committee charters, hospital posters emblazoned with "Transforming Patient-Centric Paradigms for Sustainable Outcomes." Grand words. Lofty phrases. But scratch the surface, and there was often little beneath.

I recall one particularly extravagant initiative. An all-day faculty retreat at a five-star resort. The agenda was riddled with phrases like "Leveraging Institutional Synergies," and "Aligning Core Competencies." By the end of the day, no one could articulate what had actually been achieved. It felt performative, like jargon posing as substance.

But why does this rhetoric persist? Part of it, I realized, is that institutions often reward those who appear to be making progress rather than those who are genuinely disrupting the status quo. It’s a dynamic women leaders in particular often navigate with difficulty, as societal expectations add layers of complexity. Many are forced to overcompensate, striving to appear “expert in everything” simply to hold their positions.

The Art Gallery of Academic Initiatives

This brings me to the third academic paper: a study titled "Bullshit Makes the Art Grow Profounder." Researchers demonstrated how vague, meaningless titles made abstract art seem more profound to viewers. For example, what exactly does the title "Temporal Vortex of Synergistic Alignment" offer to an abstract painting; it might as well be “As you Like It”.

The connection of that paper to the medical academy was immediate and uncomfortable.

Academic medicine, I realized, often operates like a modern art gallery. A glossy new initiative is unveiled, accompanied by a vague but impressive title. Committees gather to nod sagely at the canvas. Papers are shuffled, diagrams are drawn, and the gallery stays open for years while meaningful outcomes remain elusive.

But here’s the thing: not all canvases are empty. Occasionally, someone - a bold leader, an unassuming clinician, an overworked resident, an unsung nurse - quietly creates something meaningful amidst the noise. These moments of clarity aren’t celebrated on institutional billboards. Real innovation often happens in small, unglamorous spaces, far from institutional spotlights.

Stepping Beyond the Frame

These three texts didn’t just give me insight; they gave me a mirror. They helped me understand not only the systems I had been part of but also my role within them.

For years, I chased institutional validation. I thought success meant titles, grants, and published papers. But increasingly, I found joy in spaces outside those rigid frames: mentoring young innovators, exploring entrepreneurial ventures, dancing salsa with healthcare teams to build resilience, and designing human-centered systems that actually worked.

I realized that perhaps my time within the formal corridors of academic medicine was drawing to a close. Not because I was disillusioned, but because I wanted to move differently. More freely, more intentionally.

Today, I am part of what some call the "gig economy." I wear many hats: innovator, entrepreneur, mentor, dancer, pianist, runner, and yes, occasionally still a clinician. The title on my office door (even if virtual) matters far less than the clarity in my purpose.

 A Call to Authenticity

If Simone taught me to see the structure, Pennycook helped me see the fog, and Turpin through the art study gave me a metaphorical lens, then the final lesson is this: the real work happens beyond the noise.

It happens in small rooms (aka online chat rooms) where someone cares enough to ask hard questions. It happens in pilot projects no one is watching. It happens when jargon gives way to plain, honest words.

For those still navigating the halls of academic medicine, I leave you with this: seek clarity, stay honest, and don’t let the pseudo-profound noise drown out the quiet truth of why you began this journey.

If "Sir? No Thank You!" was a letter of frustration, this is perhaps a letter of clarity. One that maps out the path beyond those institutional walls.

The beacon still shines. You just might have to step outside the gallery to see it clearly.

In Acknowledgment: To the colleague who offered her story as a beacon. Thank you, A.N., for helping me see the canvas more clearly.

from Health & Disease

Additional Reading:

1.     Mian A. (2015). “Sir? No Thank You: An Open Letter to Medical Students & Systems.” An Itinerant Observer. Available at this link. Last accessed January 5, 2025.

2.     Simone JV. (1999).“Understanding Academic Medical Centers: Simone's Maxims.” Academic Medicine, 74(3):234-238.

3.     Pennycook, G., Cheyne, J. A., Barr, N., Koehler, D. J., & Fugelsang, J. A. (2015). "On the Reception and Detection of Pseudo-Profound Bullshit." Judgment and Decision Making, 10(6), 549–563.

4.     Turpin, M. H., Walker, A. C., Kara-Yakoubian, M., Gabert, N. N., Fugelsang, J. A., & Stolz, J. A. (2019). "Bullshit Makes the Art Grow Profounder." Judgment and Decision Making, 14(6), 658–670.