Monday, February 11, 2013

Why are doctors afraid to say we do not know ?

All the doctors will accept the fact that medicine is an imperfect science  and that there are lots of gray zone areas in medicine . Most patients will not come to the doctor with the symptoms and signs the textbooks say they should ! There are lots of variations , and sometimes it is hard to be sure about what the diagnosis is - or what the right treatment is . If doctors are unsure, the honest course of action would be to share this uncertainty with patients - to let them know that there are areas of ignorance in medicine, but that based on our practical experience of many years and our collective wisdom, we can still do our best to help patients get better .

Unfortunately , most doctors are not willing to tell patients the truth and there are multiple reasons for this. One is the fact that patients expect doctors to have all the answers. Doctors are scared that if they tell the patient the truth – that they do not know the diagnosis , the patient may feel that this particular doctor is incompetent and ignorant – and may end up seeking out another doctor , as a result of which they may lose the patient .

They therefore pretend that they know everything, and cloak their ignorance with all kinds of pseudoscientific gibberish . They make the patients undergo lots of expensive esoteric tests , which do not provide any useful information , but give the patient the impression that the doctor knows what he's doing ! Patients are awed by complex medical terms , none of which any sense to them, If the doctor can interpret these, then doesn’t this clearly prove that the doctor is an expert ? The sad truth is that none of the test results make any sense to the doctor either , but of course he doesn’t tell the patient this. He therefore indulges in this kind of skulduggery to create an aura of omniscience, but not only is this harmful for the patient , it's actually harmful for the doctor and for medical science as well, because it prevents us from exploring our areas of ignorance .

By being honest with our patients, we can actually partner with our patients as allies in a quest to further our medical knowledge . By telling them that we don’t know, they can help us to find the answers !

The true expert - the world authority in a particular field , is actually quite open about sharing his ignorance . He is willing to say – Yes, I don't know - and no one else knows the answer, either, but we can work together to find it ! Just because the doctor does not have all the answers doesn't mean that we cannot treat the patient !

If doctors learned to be more transparent with their patients, they would learn that patients have the maturity to accept that medical science is full of holes. This openness will also help patients to understand what the doctor can do - and equally what the doctor can't. This is good for patients and doctors as well – and sharing this actually helps to improve the doctor-patient relationship – after all, patients know that doctors are not God ! The problem is that this kind of sharing requires the doctor to invest a lot of time and energy to sit down and talk to the patient . By contrast, it’s much easier to just order a panel of tests and send the patient off  on a wild goose chase !

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