What if we just don’t know?

Medicine is an inexact science. We diagnose two patients with the same disorder, treat them with the same therapy, and one recovers while the other one doesn’t. I’m sure we have all had that experience. Hard core “knowledge” that we learned in medical school or residency training is later determined to be false. Then, there are all of those idiopathic conditions. When I explain to my patients that their condition is idiopathic, I am always reminded of a neurosurgery professor in medical school who said, “The term idiopathic means that the doctor is an idiot and the patient is pathetic!” Funny, and sadly, true.

And yet, our patients look to us for answers, often when none exist.
So, what’s a physician to do?

There are many instances when patients are given false information about their condition. Perhaps it’s an attempt to satisfy the patient’s inquiries or maybe the practitioner doesn’t understand the pathophysiology involved. Many years ago, I saw a patient who presented for a consultation for leg pain, holding an MRI of her spine. The pain was localized over a bulging varicose vein that had obviously been affected by superficial thrombophlebitis. When I asked her why she had an MRI, she stated that her doctor told her that varicose veins don’t hurt, so her leg pain must be coming from her back. With the increasing specialization in medicine, it’s impossible for any of us to keep up with the rapid developments in other fields.

But we can be honest when we are uncertain.

As Scott Eblin, author of The Next Level, writes in his blog, Five Rules for Leading Through Uncertainty, we should share what we know, say what we don’t know, cut the crap, ask for input, and stay engaged. All great ideas.

Patients are surprisingly open to the truth that we don’t know everything. By sharing what we do know, we demonstrate what mastery we have and allow them to share in the understanding that is available. When we explain what knowledge or understanding is lacking, we give our patient the gift of trust, a very powerful component in the doctor-patient relationship. When we admit what we don’t know, it’s easier for patients to believe what we do claim to know. Our transparency and refusal to offer an explanation that we aren’t confident in makes patients more comfortable when they depend on our judgment. It also opens up the possibility that someone else may know, and allows the patient to seek out another practitioner who might know something we don’t. Then we can learn from them! Letting our patient know that we will contact them if we discover new information is a form of partnering, an effective strategy in avoiding malpractice claims.

Another important tactic is to explain our thinking process. Taking a few moments to discuss what the available information does tell us, what more we might need to know to determine the best course for our patient, and how we plan to make the decision in the absence of any further understanding gives our patient confidence that our decisions are based on careful consideration and the best data available. And if our instinct turns out to be wrong and their course isn’t optimal, our patient will understand why we made the decision we did and will usually be more forgiving.

So, when our patient asks us questions we don’t have an answer for, if they present with a constellation of symptoms that don’t add up to a clear diagnosis, or if they react in a way that we can’t explain, we can simply say, “I don’t know.” That may be the most effective thing we can do to establish our credibility and cement their trust in us. That will go a long way toward building the type of respectful and honest relationship that we all want with all our patients.

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About Helane Fronek

Over the past 28 years I have had a fascinating and fulfilling career in medicine, initially practicing as a general internist and then as a procedural specialist, caring for patients with vein disorders. As Assistant Clinical Professor of Medicine at UC- San Diego School of Medicine, I’m thrilled to be teaching medical students crucial communication skills along with many other aspects involved in the practice of medicine.
This entry was posted in building relationship with patients, effective communication in healthcare, first impressions, honesty in medical care, physician communication and tagged . Bookmark the permalink.

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