People will occasionally ask me what I have learned from a lifetime in medicine. If I am in a playful mood, I tell them medicine taught me how to write illegibly. For all those who have wondered, the secret can now be told: They do teach a class in med school on poor penmanship. I got an A. Ironically, medicine also taught me how to type. Rather, it forced me to learn. I never took a typing class, as my plan was to write in charts until I retired. Curses upon electronic health records.
If I am more serious, I say I learned the value of critical thinking – how to take a constellation of signs and symptoms, rapidly tick through the possibilities in my mind, and craft a diagnostic approach and treatment plan. I also learned how hard it is to the bearer of bad news. This continues to be a work in progress as I constantly discover ways to do better.
But if I am asked to sum up lessons learned in medicine in one word, my answer is always the same – humility.
I concede that physicians have the reputation of being arrogant, and it is one we sometimes deserve. Yet I struggle to understand why we’re like this. The profession can slap you down in a heartbeat. There is a reason we hesitate to call medicine a science. Science has rules; medicine, not so much.
The complexity of the human body will never be fully understood as its variables are endless. We will sooner unravel the mysteries of the universe. You can do everything right in treating a patient, based on evidence-based literature and your experience, and the patient will confound you and not improve. Likewise, patients will get better and upon reflection of your care, you never quite figure out how this came to be.
My first mentor in medicine was my father, who practiced for over 40 years. He taught me so many things, but among my favorites is this: “Remember, there is no disease, that in your efforts to cure, you cannot make worse.” I have learned to think twice or more about my therapies.
Another mentor, Dr. Duncan Morton, Jr., is more succinct concerning the foibles of medicine. “Hero in one room, goat in the next,” he’d always say. And my wife, who is the smart one in our medical marriage, will merely smile at me when I am fretting over patients and reassuringly say, “That’s why it’s an art.”
Do not confuse arrogance with self-confidence. Self-confidence is being secure in the knowledge that your knowledge is sound. Arrogance is never considering that your knowledge may not be comprehensive. The great Persian physician Avicenna wrote, “Medicine is not one of the difficult sciences, and therefore, I excelled in it in a very short time ….” Not to be disrespectful of my forefathers, but I'm betting there wasn't as much for him to learn circa 1000 A.D. Plus he called it a science.
I’d like to think this bravado is a façade. Most physicians are keenly aware of how hard medicine is and how much uncertainty is always present, and thus don a mask of self-assurance. Or perhaps it is a means of ensuring the trust of our patients. Letting doubt creep into your voice may alarm them, and saying “I don’t know” can be a difficult admission.
I have found that if you follow “I don’t know” with “but I’ll find out, or find someone who does,” you have mitigated most fears. I’ve also discovered that patients realize you are not all-knowing, and thus see us in a more realistic, human light. This is critical as patients are more willing to discuss issues they may have been uncomfortable with beforehand. I am convinced that most physicians, if they have a strong bond with their patients, hear more personal things than the clergy.
In the end this is all about demystifying and demythologizing the physician. Yes, we have studied for years and know a lot of things. But you probably know a lot about your field also. Too often we are placed on a pedestal, sometimes of our own doing, sometimes by others.
One thing I’ve learned about pedestals – once you’re placed on one, the only way to go is down. If we are going to guide our patients to better health, let's make sure we're on equal ground with them to find the best road together. Sorry about that, Avicenna.