Friday, September 11, 2015

This Is Not a Board Exam Question


There's no manual for teaching young doctors. Although we do give them lectures there are no classes per se and certainly no homework. Despite our best efforts, grading is highly subjective. Mostly training is done the way it has always been done, one-on-one. The trainee presents the case to the attending (me), the attending asks a question or 2 about the details, and then says, "OK, what do you want to do." Depending upon stage of  training, overall competence, and level of courage, the trainee's opinion of what should happen next will vary from spot-on to near malpractice. As is always the case,  teaching the bright ones is  easy. Teaching the dullards bears some similarity to the carry-and-drag event in the World's Strongest Man Contest.

There are many different ways to categories to categorize patients, by disease type or severity, by age or demographics, by prevalence or prognosis. But the way I often chose is to ask; "If you asked 10 doctors how to treat this problem, would they all give you the same answer" That is what I like to call a Board Exam question. There is enough consensus about a particular diagnosis or treatment that all are in agreement what the answer should be. That doesn't mean, alas, that what we currently believe is true will always remain so; cardiology has more than its share of once-accepted  treatments now discredited. Yet there is a broad body knowledge that endures, the mastery of which is considered essential.

Often, however, the answer to my question will be not be so simple. There may in fact be no sure answer at all, just a best guess as to how to proceed. A good doctor in these situations is comfortable with uncertainty. He/she accepts the burden of making decision with incomplete information, and under sometimes rapidly changing circumstances. He/she understands that things may look quite different in a day, or even an hour, and, acknowledges that sometimes one needs to change course. Being willing to change one's mind is sign of wisdom, not weakness.

If only someone could get that message across to our leading Presidential candidates.


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