As a patient, the words from a
doctor that give me most confidence--- if not used too often---are
"I don't know".
This is because the professional who is secure in his or her
competence will never hesitate to admit the limits of expertise. The
corollary is that when such a professional says he or she *does*
know, one can believe it.
Also useful is "I don't know---go and look it up on the Internet
yourself!"
Competing interests: None declared
Ignorance in a Developing Country
20 July 2003
Prathima
Reddy,
Consultant - Obstetrics and Gynaecology St Martha's Hospital, Bangalore - 560001, India
I returned to India three years
ago after training and working in the UK for nine years.
I noticed that many of my colleagues (especially the junior ones)
found it difficult to say to a patient "I do not know".
When questioned about this they gave me the following answers:
* "I do not know" is unacceptable to most patients
as they perceive it as a mark of one's inefficiency
* I may lose my patient to another doctor who can
answer all their questions
I see a lot of patients who are uneducated and expect miracles
from doctors. But with patience and time they reconcile themselves
to the fact that we are not God. And in the long run appreciate you
for your honesty.
A small minority of course, move onto doctors who can answer all
their questions - truthfully or not.
Competing interests: None declared
Certainty may take some time
20 July 2003
Michael L.
Loren,
Assistant Clinical Professor, University of Kansas Independence, MO 64057
It is better to say that you
suspect a diagnosis but you are not sure, yet. We are not expected
to have an immediate diagnosis at every encounter. Sometimes a
followup visit with more history will clarify a diagnosis. Time may
improve our accuracy.
The "i dont know"clause is
perceived as a negative attribute in the developing world where
patients dont understand why a fully qualified doctor having
practised for 20 odd years still has to look into a book (usually
the BNF or the local variant) to prescribe a drug- even penicillin
by some these days!!
Specialisation has increased the incidence of the phrase in
question and is perceived as a very acceptable loophole (atleast in
medical circles) for the "general physician with an interest in
everything else except the patients' current ailment!!"
If something does not form part of your daily working knowledge,
it becomes part of the "I dont know" area. Examiners these days are
satisfied even if doctors dont know the answer but know where to
find them. "I would phone the drug information department" - 10
marks!
The way the world is going I feel that even when talking to
patients, probably the important bit is what you say after your
favourite clause... I dont know, but will find out from..... 10
marks! patient is willing to wait till you find out from the chest
physician what antibiotic to prescribe for moraxella catarrhalis
Competing interests: None declared
giving a diagnosis for LBP
28 July 2003
John M
Ventura,
clinical instructor, University of Rochester School of Medicine,
Dept of Family Medicine Rochester Chiropractic Group 1687 English Rd Rochester, NY 14616
Studies which have looked at
patient satisfaction relative to LBP have consistently ranked
chiropractors higher than medical physicians. When the specific
variables which account for this disparity were analyzed, they
consisted of the following: chiropractors more frequently provided a
cause for the pain, more often provided advice on home management;
patients also felt medical physicians were less confident in their
diagnosis and management and showed less concern.(1)
Providing a likely tissue of origin for the mechanical LBP isn't
an insurmountable task, though there does exist an inordinate amount
of variablity in this process. What is neededed is a diagnostic
classification system for mechanical LBP, that may or may not
include tissue specific etiology. We have proposed a functional
diagnostic classification system utilizing information from the
Quebec Task Force on LBP and a model proposed by Wadell.(2)
Sincerely,
John M Ventura, DC
private practice of chiropractic
clinical instructor, dept of family medicine, University of
Rochester School of Medicine
adjunct assistant professor, New York Chiropractic College
(1).Cherkin DC, MacCornack FA, Berg AD. Managing low back pain-a
comparison of the beliefs and behaviors of family physicians and
chiropractors. West J Med 1988; 149:476-80.
(2)Ventura JM, Justice BD, Ianelli G. Developing a quality based
chiropractic practice. Chiropractic Technique 1997; 9(4):157-61.
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