Every time I listen to a continuing medical education podcast or talk at a conference, I come away shaking my head. I’m always moved by how much information we’re supposed to withhold, how quickly new data and therapies emerge (and old ones get pushed aside) and, of course, the absolute rock stars that populate the world. of emergency medicine.
This can be a bit daunting for me as my beard is turning gray and I fear obsolescence. Well, it would be without something every honest doctor knows: each of us has gaps in our knowledge.
Sure, some have encyclopedic brains and eidetic memories, and I like that they exist. But most of us are not like that. Most of us are smart enough, creative enough, persistent enough, and just plain tough enough to keep up the good work of taking care of the masses of people who rely on us around the clock.
We know how to identify things out of the normal, we know who is really sick, and we have effective methods for finding what we need to know, either in books (remember books?), online, or by contacting someone who is an expert on the subject at hand.
Certainly, the last two years have given us painful clarity about our limits. Faced with a dangerous and highly transmissible new virus, none of us really knew what to do. This honesty that was refreshing when the forums and articles online all seemed to show that we were in new territory and looking for new ideas.
But this reality extends far beyond COVID-19 and into more mundane areas. Working as I do in small hospitals and resort areas, it’s not uncommon for someone to tell me that their child is sick and has a rare and complicated genetic abnormality. “You’ve heard of Messinger-Drown chromatin dissolution syndrome, haven’t you? »
“Never in my life,” I answer honestly, “but tell me about this and how I can help you.” Then I run on the phone or the Internet.
It also happens when patients come in a day or two after receiving a new cancer treatment or surgery that is not done at my facility and is relatively new. I end up asking their doctor (or more likely their on-call NPP) to tell me what to do.
But there is more. Sometimes even fairly simple things escape our memories and skills. I think I gave birth to a baby in about 15 years. Thank goodness it was in labor and delivery with specialist nurses and only because the doctor had arrived late. I occasionally read articles about difficult births and breech presentations to jog my memory, which makes my forehead sweat.
None of the facilities where I currently work offer obstetric/gynecological care, and such things are frankly horrifying to me, especially when transfers are hard to arrange and ambulances hard to find.
But some things I know well. I can handle a copperhead or rattlesnake bite with the best of them; I see them every summer. Many of our urban colleagues never have the opportunity and even find it difficult to identify venomous snakes. Not because they aren’t brilliant doctors. It’s just that they don’t use this information regularly.
Seriously ill children? I can handle them, but I don’t often so I call for help. Complex overdoses? Poison control is a constant source of reassurance.
The gaps in my knowledge are highlighted when I work with my amazing young colleagues, all of whom bring new processing algorithms and scoring systems. (“Her METH-HEAD score is 19, so she should be able to get out later.”) They light me up at the shift change and I nod. When they leave, I check MDCalc to find out exactly what they meant.
During that time, they ask me things, and I come up with insights and insights from my decades of experience that they haven’t considered. We respect each other and there is no judgment on who knows what. We all do our best, and remarkably, it almost always works and patients do well.
I took my second ABEM recertification exam a few years ago. I came across several items regarding the management of radiological accidents as I went through the questions. These were probably difficult for some candidates but easy for me, but not because I had reviewed them diligently before the exam. Statistically, it was an unlikely topic. I knew the answers because I spent many years on a radiation response team working with our local nuclear power plant.
That doesn’t mean I’m awesome; that’s how things happened. Without it, I probably would have been blinded by these questions. A simple thing for me was probably a shortcoming for someone else. In a specialty as encompassing as ours, there will always be things like that on exams and at the bedside.
I often wish I could take a few years off and recheck the basics of medical school. What a beautiful thing it would be to go back and take everything I’ve seen and done and explain it to me now. (I mean, germ theory was apparently a game-changer!) Imagine the joy of realizing why things work the way they do and, of course, the horror of realizing that some things I never understood.
Perhaps we should all recognize another truth that is a common medical leveler. We’ll retire at some point, and given the pace of medical research, it won’t be long before we’re (how to put it delicately) out of place. This is how life is in every profession based on vast amounts of information and specific physical skills.
It would be a wonderful time if we could sit together and confess our intellectual shortcomings. Our specialty is full of brilliant doctors, but I take comfort in the fact that we all have things we don’t know. We rarely admit it.
Dr Leappractices emergency medicine in rural South Carolina and is an opinion columnist for The Greenville News. He is also the author of four booksLife in Emergistan, available athttps://amzn.to/2T60WET, and Work knights, cats don’t work, and The practical test, all available onwww.booklocker.com, and a blog, http://edwinleap.com. Read his past columns onhttp://bit.ly/EMN-Emergistan.