I Don’t Know

When said by a doctor to a patient “I don’t know” can be the scariest phrase possible. The fear of the unknown is one of the toughest to deal with and people tend to assume the worst.  Coping with such thoughts can be very difficult.

Meanwhile doctors hate to say it.  We go through years of training and are taught from the first day “Take charge, make a decision.”  We want to make a diagnosis and fix the problem. But truthfully, we cannot always do that, and making something up would be far worse.

So what does a doctor do when he is unsure?  The first thing any doctor does is ask themselves, what is the worst case scenario with this condition.  If these consequences are minor, then treatment with a best guess and careful follow up may be appropriate.  But the phrase “I don’t know” generally isn’t necessary with minor situations.

In more difficult cases a doctor may have another doctor examine the patient and then jointly develop a plan of action.  Or a referral to a specialist may be appropriate.  The “I don’t know” has become “I don’t know, but I will find out”.  Simply having a plan of action developed in conference, or a referral to a specialist, can be very reassuring.

Personally, I do a significant amount of general eye care.  But there are areas of vision which I am less familiar with.  In these cases I am lucky to have partners who have more experience, and I may ask for a quick consultation.  Often times, a referral is more appropriate.  In these cases, I will often step out of the room and set up the appointment for the patient before I say “I don’t know.”  This way, I can immediately follow up with “But here is how we are going to find out.”  A small change but it makes a world of difference.

Doctors are often concerned, if they make a referral or ask a colleague for help they will appear less professional.  I find in either situation patients are reassured that they are in good hands and are less apprehensive.  Counter-intuitively I also find that they are more confident in my abilities.

“Dodge”

William Dodge Perry, OD

Falls Church VA