When doctors should admit they don’t know

After graduation from m medical school, as the news broke out among family and friends that I have started d a house job at ‘the most prestigious’ hospital in town, I started receiving curbside consultation requests. First it was one of my mother’s friend, asking for my opinion if she should go for knee replacement surgery or not. With an inflated ego, I was ready to give her free advice based on my ‘vast experience’ of knee surgeries, which of course was limited to seeing a couple of postoperative patients during an orthopedic clerkship in my final year of medical school. Then an uncle showed up at our house, ready to unload his whole medical history from 20 years ago when he had once fallen, till recently when he pressed the car brakes a bit hard. He thought he also might have whiplash. Playing the role of a spine specialist, I was eager and ready to give my two cents. Then there was a friend of mine who was struggling with infertility and had been to various medical centres in town. It did not take me much time to find a ‘solution’ for him once he asked for help. At other occasions, I acted like a cardiologist, a psychiatrist, a nephrologist, a neu- rologist, an oncologist and what not. I was a free advice expert. I stood, at the front of everyone’s problems, with a swollen ego, as I was being looked upon for solutions to everyone’s medical quandaries. However, in all of that, it did not occur to me that my good-willed but half-baked advice may be doing more harm than good. It never crossed my mind to tell them that their medical problems were beyond my expertise of being an intern. I was a fresh graduate from a system where I learnt about public toilets in great details, but not a single lecture on medical ethics. I had earned a degree, but not the responsibility that comes with it. So I did not know how and when to admit ‘I don’t know’. Giving free advice was a noble act and not something to feel accountable for. I thought I was paying back to the society by this noble act. I am pretty sure I was not the only one in this quagmire. It’s prevalent in our society that people openly share every detail of their medical history with family, friends and especially if there is a doctor in the neighbourhood.Doctors on the other hand, are ready to generously and sincerely share their advice, sometimes not really knowing the full extent of patient’s problem. This culture is not specific to new graduates; unfortunately it has plagued the entire medical community at multiple levels. When should a doctor tell his patients ‘I don’t know’ is a tough question. Physicians during their training and education are primed to answer questions. Not answering is not an option and ‘I don’t know’ never gets rewarded. Medical practitioners are pressured to make a clear diagnosis and a straightforward treatment plan. Patients come with high hopes and expect black and white answers, often to some very complicated questions. What most people don’t realise is that medicine is an ocean of uncertainty and doctors are the navigators of this ocean. Doctors read text books, but diseases don’t. Doctors make algorithms, but diseases may not follow them. Doctors follow medical guidelines, but these guidelines often change. Years of practicing at high complexity tertiary care centres has humbled me. Not a day passes by without making me realise how much I don’t know. On top of this, an increasing pile of medical journals and research articles on my table keeps increasing my sense of ignorance. Should this sense of ignorance be shared with patients? Will they deem their physicians as incompetent? Will the doctors lose their patients’ trust? All of these are barriers for a doctor in admitting ‘I don’t know’ to their patients, when they really don’t. Contrary to what most physicians might think, evidence in medical literature is clear that patients trust their doctors more when they are honest with them. This may entail admitting a mistake, not knowing a diagnosis, being unaware of a treatment plan, or not been able to perform a procedure. If doctors take time to educate their patients about the complexity of a disease, the work needed to reach a definitive diagnosis, pittfalls in the treatment plans, and any limitation of treatment options, it will increase trust in their doctors as well as in the medical profession. When patients realise their doctors are working hard to sort out the problem, they bond with them more and tend to develop trust quickly. After all, a right diagnosis is more important. Learning medicine is a science, practicing it is an art. In my first feedback meeting, my residency programme director and mentor, Dr Todd Gress, taught me a sentence that never let me down in 20 years of practicing medicine: “I don’t know, but I’ll find out”. Dr. Sarmad Chaudhry is a Pulmonologist and a Diplomat American Board of Internal Medicine, Pulmonary Diseases and Critical Care Medicine. He has a keen interest in community education and creating awareness about medical problems.