“I don’t know” is a phrase that I labored to forget and prevent myself from uttering as a med student and resident. I was taught that allowing others to hear me say it would be detrimental to my reputation and perceived status. Patients would lose trust in me, nurses would not respect me, and senior residents and attendings would look down on me and challenge me.
“Never say, ‘I Don’t Know.’”
This command rang in my head repeatedly during my years in clinical settings. However, when I began performing in-home health assessments, I came to an honest and sobering conclusion: We as physicians and health care professionals do not know much, if anything, about the patients we see, and our failure to identify or accept this fact is perpetuating or causing health problems in many.
We base the knowledge and recommendations we share with patients on the information we have learned, heard, or gained through our own personal experiences and education. This information pertains directly to other individuals — study participants — not our patients. I firmly believe and continue to gain more evidence to support the notion that everyone’s body is different and functions differently. Therefore, can we adequately apply guidelines and standards of care derived from acceptable studies to individuals who may share some characteristics with those in study groups? Should we make the assumption that results observed during the study period will predict those seen in our patients? Is it worth the risk?
Acknowledging what’s unpredictable
Even if by chance a patient happened to be part of a study that investigated a certain pharmaceutical or therapy, do we really know how the drug will affect the patient outside of the controlled research environment? We have to question possible outcomes since the patient’s medical condition will be affected by external factors and the patient may not adhere to the strict regimen provided by the researchers. Variables known and unknown to the research team will now have the opportunity to affect the patient with consequences that cannot be predicted. In light of this, I believe we have to be aware of how we present this information to patients.
Instead of doctrines written in stone, such as, “You need to follow this diet,” or, “Your cancer will cause _____,” I recommend focusing on the possible risks and how they may apply to the individual patient, because exam findings and test results do not tell the whole story. We cannot honestly tell individuals what will happen to them because their unique physical make-up and lifestyles play crucial roles in their outcomes and health status, and our brief encounters with them do not provide the opportunity to gain insight in these areas.
The promotion of “healthy” habits and practices is an area that needs to be addressed, as well. First and foremost, what is “healthy”? It may sound strange, but I am no longer sure what characteristics to use in order to determine the classification of healthy. We as physicians believe that the term “healthy” is one size fits all. But, do we really know this to be true?
For instance, not everyone can tolerate eating fruits and vegetables. Can they then be classified as healthy? Conversely, smoking does not cause disease or ailments in every smoker. Can smoking then be classified as unhealthy?
Patients ask these questions as well. Unfortunately, they often refrain from asking in the office and many times keep them to themselves until motivated to share their thoughts during a discussion of their lifestyle practices. My current experience has shown me that ignorance or lack of knowledge is not what is preventing individuals from participating in preventive care or proper health management. Often, it’s confusion and/or lack of motivation derived from the individuals’ view of the world and of themselves.