When Justice Meets the Judge

The shadow side of good values in medicine...

I’ve learned that even good values have edges. Justice, for me, especially.

We talk a lot about values in medicine: integrity, compassion, excellence, justice. But I’ve learned that even our best values have a "shadow side". Sometimes, even justice needs grace.

In training, most physicians absorb the implicit lesson to seek out and be critical of others’ mistakes. I was no different.

As an early attending, I remember taking a report from an outside clinic to my lead and pointing out how the other physician had failed to act on a vascular finding. The patient was fine, and I had already arranged the follow-up, but I wanted to make sure the gap was noted.

My senior partner listened and said quietly, “Never be too quick to judge. We often don’t have the full story.”

I nodded politely but didn’t fully absorb it until a couple of years later, when our fax line from radiology went down without anyone realizing it. For weeks, reports never arrived. One of my patients ended up with a delayed diagnosis.

That was the moment the lesson sunk in. It turns out perspective changes fast when the same story lands at your own door.

Since then, I’ve coached many physicians who carry that same drive for justice, a noble value in and of itself. Their hearts are anchored in doing what’s right, but over time, the weight of that responsibility becomes heavy. The constant moral outrage at what’s broken in medicine takes its toll.

We talk about what’s theirs to carry, what’s within their influence, and what it’s costing them to act or stay silent. Then we explore what that value looks like when it’s at its healthiest. How would they recognize it? How might it sound if it spoke with humility instead of control or blame?

Often, that’s when proportion starts to return,conviction softens into clarity, and the work feels sustainable again.

It was later, when I came across Shirzad Chamine’s idea of the Judge (the part of us that masquerades as discernment but thrives on criticism) - that’s the lightbulb moment for me. That was my Justice value, hijacked!

The Judge sounds a lot like Justice when it first speaks up. It wants fairness. It wants high standards. But it’s distorted.

The Judge is all about control, perfection, and self-justification. It convinces us we’re being discerning, when really we’re just tightening the lens until no one measures up, including ourselves. Eventually the standard becomes so high that fairness turns rigid and judgment becomes the default.

It took me a while to see that this wasn’t Justice without boundaries. It was Justice distorted. What started as a value had slipped into its shadow, where the drive for what’s right turns rigid and critical.

The work isn’t to abandon Justice. It’s to right-size it, keeping it aligned and proportional.

When the Judge starts to take over, it can often help (once you recognize it) to ask which other core value brings balance.

For me, that’s Faith in which Grace is embedded. It reminds me not only that I don’t have to always be the noticer, judger, and fixer of all situations. But also, it reminds me of my, and others’, fallible humanity.

It’s easy to celebrate our best values, the ones that got us into medicine in the first place. But the longer we practice, the more we realize that even good values have edges.

Integrity can harden into rigidity. Justice can twist into judgment. Excellence can slide into perfectionism. Compassion can turn into martyrdom.

(And don’t even get me started on values without boundaries… maybe that’s a story for another day.)

Reflection:

Which of your core values drives most of your choices and actions?

What does it feel like, what are your internal cues, when your value is balanced versus when it trends toward distortion or the “shadow-side”?

When you notice the shift, what practice or other core value could help restore proportion or perspective?