Make the Most of Your Ignorance: Admit, Research, Report Back
Pretending to know more than you actually know is a deadly sin in medicine. We can’t know everything and even things we think we know may have changed since the last time we dealt with them. We are supposed to be lifelong learners, so I actually strive to show that to my patients quite often. Of course, a lot of what we do requires no double checking of the literature, but when dealing with things we run into less often, this is what I do:
For less common medications, I pull up my iPhone and check epocrates for dosing guidelines. I also then rattle off the common side effects straight from my phone. I use the interaction checker if I have any concerns, rather than wait for my EMR to stop me as I’m prescribing the new medication.
For treatment choices or diagnostic criteria, I mostly use UptoDate. As I pull it up on my laptop I usually say, “I pay $500 a year for this database out of Boston. It is constantly updated and very comprehensive. I want to make sure nothing has changed since the last time I treated this”.
Sometimes I use Google. I might then say, “I’m googling if there are any new articles on this from the leading medical journals or universities”.
If I’m planning to call a local specialist, I say that. Why wouldn’t I show that I have connections who are willing to give me advice?
In my new job, I have access to a network of specialists all over the country, who will give written recommendations within hours or less through the computer. I can’t imagine patients aren’t reassured by this backup system.
I have never found a patient upset, suspicious or alarmed that I sometimes need to check things in real time or leave a question unanswered until I have done my research. And when I later call them back with the information I needed, most people are very pleased. In those few cases where I thought I had a good plan and later call them back to say I’ve done more thinking and more research on the best way to address their problem, I have heard my patients show extra respect for taking my job and their situation seriously enough to do that.
That you actually take time with patients when you see them, and even call them later with more information…sigh. I get one appointment a year with my PCP and she tells me if anything comes up before then, to go to Urgent Care. My electrophysiologist also says “see you in a year” but I’m going to assume that if I have any severe electrical issues with my heart in between my yearly visit, which is probably not likely, he will fit me in. Either that or the ER, eh? Admittedly, we have an extreme shortage of doctors in NM, but typically I’m given orders for blood tests, etc., and even when the results aren’t within parameters, I get no comments from my PCP in my patient portal, so I will “assume” that because they’re not way out of whack, plus given my age (73) which gives more leeway, that all is okay.