Here are the three most useful words for a doctor: “I don’t know.”
A close second would be “I’m not sure,” another three that have got me out of trouble more times than I can remember. The older I get, and more experience I have, the more useful it becomes.
Pattern recognition is essential in effective medical practice. So often patient complaints are vague and nondescript, and in the absence of physical signs, the most effective thing for a doctor to say is, “I don’t know, but it does not sound serious.”
When I tell someone with dizziness that I don’t know what the cause is, I’m already pretty sure about what it is not — hypertension, stress, migraine, Meniere’s Syndrome, acoustic neuroma, multiple sclerosis, etc. Some tests may be needed along the way — again it depends on the pattern and one’s own experience.
When there are worrying symptoms or physical signs, “I don’t know” needs to be followed by, “but here’s what we’re going to do to find out.” Again pattern recognition and experience come to the fore.
All too often, especially among junior doctors, there is pressure to make an absolute diagnosis, and this involves test after test, doing no one any favors. The truth is that accurate diagnoses for minor non-specific complaints will be impossible. It is here where an honest “I don’t know, but it doesn’t sound serious” is valuable. Some patients need to be told in addition that there is no evidence of serious disease.
Somewhere we doctors have been taught that a diagnosis is expected every time, and then followed by a drug prescription. In many cases all people want to know is that we find nothing wrong and it does not sound serious.
An essential follow up is, “but if it does not get better, or becomes worse in any way, see me again.”
Coupled together, these two sentences go a long way in providing honest and open medical reassurance to patients.
Martin Young is an otolaryngologist and founder and CEO of ConsentCare.
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