Today was one of those days when I knew why I went into medicine. Among my new patients were two with complicated medical histories. One was treated by a physician and improved. But a second physician emphatically told her she should never have had the treatment. She worried she had made a poor decision that might affect her long term health. In fact, the treatment was appropriate. The second physician was simply uninformed, and rather than admitting he didn’t have experience in this area, or becoming curious about why the treatment was done, he assumed that his superficial knowledge was all there was to know. It felt good to put her mind at ease and explain why the treatment was helpful.
The second patient continued to have pain in her leg after treatment. Her physician told her that nothing more was wrong with her and she was “fine.” It was easy to see from her physical exam that she wasn’t “fine,” and an ultrasound confirmed an easily fixable problem. When we aren’t successful in alleviating a patient’s pain or improving their condition, it’s sometimes easier for us to declare that there is nothing more to be done, rather than admitting that we might not have the answer.
We spend countless hours trying to know – the symptoms of diseases, their natural history, treatments and their side effects. We spend hours practicing techniques so we succeed. But no matter how much effort we expend, there will always be things we don’t know and treatments that don’t work as expected. How can we reconcile this with our desire to be of help to our patients?
When I told the second patient I reviewed her records and read some literature on her condition, tears came to her eyes. “You read my records?” she asked. “That really means a lot to me.” While most patients want the very best results, they also understand that doctors cannot know everything. In her recent New York Times editorial, Danielle Ofri, MD, PhD, an internist at Bellevue Hospital in New York City, addresses this fact. She argues that recertification exams, which require us to memorize rarely used details, are a waste of a doctor’s time. Instead, she suggests that exams be taken the way that medicine is practiced – open book. Calling a colleague, reading an article or checking a textbook serve to fill in information we don’t have at our fingertips. Using these resources is an effective and reasonable way to practice medicine. My patient understood that I didn’t know everything about her and appreciated that I tried to learned more. She wasn’t deterred when I admitted there were things I didn’t understand. What she wanted was for me to acknowledge her pain, to care and to put forth effort on her behalf. When we do that, we build rapport, attend to our patients’ needs, and acquire more knowledge as we go. I’m with Danielle Ofri – the practice of medicine should be open book, fueled by curiosity, and we can feel just fine about that.