If you don’t know a yes from a no,
And if you can’t tell the fast from the slow
Listen up, please,
For I can do it with ease,
Just say out loud, “I don’t know.”
Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. Assignments in Nome, Alaska, rural Iowa, and suburban Pennsylvania stretched into fall 2015. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, and short jobs in western Iowa and Alaska, I am working in Clarinda, Iowa. Any identifiable patient information has been included with permission.
Over the weekend I observed the anniversary of my graduation from medical school. I remember the night well; I went out to the Chinese restaurant in East Lansing (at that time, there was one) with my father and my brother. My fortune cookie said, “You will have great power over women. Use it wisely.”
Before and after I have heard many commencement speakers, but the only one I remember was the one from March 11, 1979. “When you get up in the morning,” he said, “First thing, look in the mirror and say, ‘I don’t know.’ Practice it. Get good at it.” I remember a good deal more of that speech, but that particular commandment came to my mind this morning.
The patient came in for follow-up of cough. He had had all the right treatments before he got to me, but he wasn’t getting better. I repeated the chest x-ray and didn’t see pneumonia. Antibiotics, steroids, breathing treatments helped but not nearly enough, and he felt worn out from the cough bothering his sleep. I said, “I don’t know what’s wrong, but, clearly, something is wrong. And I know exactly what to do when I don’t know what to do, and that’s to send you to someone who knows more than I do. Because I’m the world’s final authority on nothing.” We were lucky to get him a follow-up appointment with the pulmonologist in a week.
But at the end of the visit I told him about my medical school commencement speaker, and how good I’d gotten at saying, “I don’t know.” And then I asked permission to write about him in my blog. “I won’t say name of course, or age, or gender, but…”
“Doc,” he said, “You can tell ‘em my name is ### and I’m ## years old and I’m ### for all I care. Especially if it’ll teach other doctors to admit when they don’t know.”
I can hope.
An awful lot has changed in medicine since 1979. We don’t use penicillin for pneumonia any more, and rarely do we bring out the digitalis. But doctors still have to admit when they don’t know. It’s one of the rules of the game.