Eric Grosch, Letter to Dr. Morgenstern on LOR - Semmelweis ...

and anecdotal experience, both as an author and subject of LORs. Most of what I say here is in
the public domain and obvious. I get the impression that nobody ever puts it <strong>to</strong>gether, so I've
done that, though, perhaps incompletely. If you have any objections <strong>to</strong> what I've said here, please
let me know them.
I divide my reasons in<strong>to</strong> generic sections:
1. Golden Rule: Do un<strong>to</strong> others as you would have others do un<strong>to</strong> you. The Golden Rule[2],
alone, should persuade anyone with any insight in<strong>to</strong> the treatment that he would ideally prefer for
himself, that the performance-appraisal/LOR can never work.
2. Comparisons are always odious.
3. Deleterious effect: The idea of performance-appraisal is fundamentally flawed, even
dysfunctional, because of the often deleterious effect it has on those trainees that appraisers rate
as less than the very best, even though quality of performance is a lottery, governed in large part
by random chance. Accordingly, rating people who are of the system makes no sense.
4. Improper substitute for “where do I stand”: LORs and performance-appraisals serve the
organization or institution, not the individual appraised.
5. Inaccuracy:
a. misapplication of the Likert-scale principle
b. inevitability of rating-inflation
c. popularity-contest
d. mismeasure of “excellence”
e. men<strong>to</strong>r-inattention: Men<strong>to</strong>rs, who are supposed <strong>to</strong> do the evaluations and LORs, don't pay
enough attention <strong>to</strong> their trainees' performance <strong>to</strong> fulfill that function adequately because their
contact with trainees is minimal and sporadic, so their appraisal of the performance of their
trainees is most often inaccurate and may even reverse the reality on the ground.
f. self-fulfilling prophecy
g. absence of evidence-basis
h. glittering generalities: Even if men<strong>to</strong>rs paid attention <strong>to</strong> trainees' performance, the rating
systems that they use address only glittering generalities, such as “general medical knowledge,”
require presentation of no supporting evidence and rarely <strong>to</strong> never address the only index of
work-performance in medicine, namely, clinical outcomes of patients under the trainees' care.