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At the heart of general practice since 1960

It's OK not to know

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It’s a heady feeling, when somebody first takes your medical opinion seriously. I think that for most of us this watershed moment comes whilst still a student. You’re sat with a group, at home or in the pub, and the discussion turns to a public figure’s recent health battle or a distant relative’s operation. You’re asked to volunteer a view on their illness and its treatment, and you do so, tentatively at first. Incredibly, your assessment is taken seriously. A warm glow spreads, and you start to think that maybe a five-figure millstone from the Student Loans Company isn’t such a bad thing after all.

Sadly, the reality of postgraduate medical practice is that the warm glow is in short supply. Signs and symptoms often show a pig-headed unwillingness to do what the textbooks say they should. The scenario you dreamt of as a student, when you tie all the loose ends of a case into a neat phaeochromocytoma or eponymous syndrome, stays as a pipedream. Eminent professors fail to phone up and confess in broken tones that the test you ordered has cleared up a puzzle that had baffled them for years.

Nevertheless, when you start out it’s with a feeling that most things can be made explicable, if you try hard enough. It is only in the last couple of years that I’ve learnt that it can be alright to confess ignorance. Obviously, circumstances matter. Saying ‘I don’t know’ can sound reasonable in a calm consultation with a patient you know well, when you are both certain all the sinister causes for their inexplicable symptoms have been ruled out. It would probably sound less impressive shrieked over your shoulder when someone asks what to do about a patient collapsed in the waiting room.

Looking back on my earlier years in practice, I’m surprised that it took so long to realise that saying ‘I don’t know’ can be OK. It used to embarrass me. Perhaps this reticence is peculiar to the kind of oddball who thinks his musings are worth sending to Pulse, but observation of colleagues would suggest not. We’ve all been scientifically trained, we’re conscientious, and we want to be able to help our patients. I suspect we also want to feel that those endless years of study were worthwhile.

As I’ve come to realise, acknowledging limitations - both in ourselves and in the state of medical knowledge as a whole - is an important part of our dealings with patients, and nothing to be ashamed of. As GPs, we’re bombarded with problems from every branch of medicine, as well as social problems with roots several generations deep. We shouldn’t stop striving to be the best we can with all of these. But life is never tidy and the honest answer, more often than my younger self would like to admit, may well be ‘I don’t know’.

Dr Nick Ramscar is a GP in Bracknell, Berkshire

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