by Jarrod Shapiro, DPM Joined practice July 2006 of John K Throckmorton, DPM Lansing, Michigan

I'll admit it: I don't know everything. In fact, I relearn this every day I practice medicine. Over the recent weeks, the practice I work at hired a new billing service. For the entire time of my boss' practice (about 27 years) he has been doing the billing out of the practice. Due to some recent problems we decided to hire a billing company. These folks came to the practice to begin educating our staff on the proper methods of billing, and I decided to hang around and watch and learn something. Learning any new skill, whether it's a new procedure or a new concept requires a self-admission that "I don't know everything." Admitting ignorance can be a very difficult thing for many of us. I remember during residency my attendings were very cognizant of this fact.

For some reason it seemed an unstated rule (at least among residents) that you had to know everything about whatever topic was under discussion. If you didn't know some anatomical fact or clinical concept you were somehow deficient. It seemed better to pretend knowledge than admit your ignorance. Most of my attendings, though, knew about this (probably because they went through it themselves). Would it not be a better learning environment to admit when you don't know something and have that deficiency taught to you while you have the chance?

Residency should be a safe environment for you to LEARN, not to pretend to already know everything. If you know it all already then why are you in residency? Are you obtaining a graduation certificate or are you learning? I haven't met a resident yet who was so good they had nothing left to learn.

What about in clinical practice? The pressure to know it all out in the real world is just as intense. Patients come to you for your knowledge and skill as a doctor. They want someone who will cure their ailment. On the other hand, you won't always know what the problem is. If that were the case you'd never need xrays, MRI, or blood tests. In fact, there wouldn't be such a thing as a "differential diagnosis" since you'd already know the exact diagnosis. So, how do you reach a happy medium? How can you satisfy your patients' desire to be diagnosed and treated while maintaining your image as the physician to which they should come for care?

One word: HONESTY. First, be honest with yourself that you don't have all the answers — you never will. No one's that good. We reserve that honor for the divine. Then, be honest with your patients. If you're not sure what's wrong, tell them. Then present to your patient what methods you're going to use to figure out what's wrong. This may include anything from more tests to a referral for a second opinion. Most patients will appreciate your honesty and candor. If they don't, it should be a warning sign. The same holds true for residency. Be honest with yourself and your attendings. If you don't know something tell them, but don't expect them to hand-hold you and feed you the answer. The next words out of your mouth after "I don't know" should be "…but I'm going to find out the answer as soon as we're done here." Your patients and your attendings, will be happier and better off for your honesty. And so will you.

Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]