Wednesday, June 16, 2010

Being Confident About Ignorance

When I started working after residency, I laughably thought that I had to know everything. And I also imagined that patients expected me to know everything. Boy, how quickly I learned! Now I know that there is absolutely no way I can know everything, and that my patients most definitely do not expect me to know everything. But they do expect this: that I ought to be extremely confident in stating what I do and do not know. In other words, when I do know somethings well, I should be able to communicate it confidently and clearly. And when I do not know something, I should be able, with equal confidence, to admit my ignorance. They don't want "half-baked" responses. And they can sniff out when I am floundering for an answer a mile away! It is much better to simply say, "I don't know." Here are some ways that I have said that:
         "That is an excellent question! And I have absolutely no idea!" 
         "In my 10 years of practice here, I have never heard anyone ask me that question before!"
         "I really don't know. But if you give me one second, I can look it up for you."
         "I'm going to have to think about this one. Give me until our next appointment to sort this out. I want to do some research on this."
         "If you don't mind, I am going to have my partner look at this also. Sometimes two minds are better than one." 
         "That is not something that I am good at evaluating, if you don't mind, I'd like to refer you to a specialist to see if they can help us figure this out."
         "I'm not sure what is causing your symptom, but I will do my very best to help you find out. We will make of list of some possibilities and start crossing them out as the tests come back."
Over the last ten years, I have found that I have needed to say these things less often. But it's still good to remember that no matter what questions may come up, simply saying "I don't know" is nothing to be ashamed or embarrassed about. On the contrary, I have found that when I am brutally honest about my ignorance, patient will trust me more about the things that I do know. 


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