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Are doctors afraid to say "I don't know"?

I love podcasts and one of my favourites is Freakonomics from maverick economist, Steven Levitt and his trusty journalist sidekick, Steven Dubner. Levitt has an uncanny ability to suck the humanity out of any topic you care to mention. I mean this as a compliment - by humanity I mean emotion, moral repugnance, prejudice, irrational thinking, etc.

In a recent podcast Levitt made an interesting observation – academics tend to spend their lives admitting that they don’t know something and then setting out to uncover the answer. People in business, on the other hand, seem to always have an answer for everything – even if it’s wrong.

He proposes a number of theories as to why, and then postulates that this tendency is responsible for a significant amount of misinformation and mischief in the business world.

So, I got to wondering - do doctors generally fall into one camp or the other?

Doctors are trained in the art (or science) of diagnostics - a process of eliciting an answer, much like the research process. On the other hand, that answer is generally pre-defined and it would be fair to say that most clinicians, and indeed their patients, expect an answer to be forthcoming.

One glance at the statistics on iatrogenic illness and deaths (usually in the 10-20% range) would suggest that all too frequently that answer was incorrect, and responsible for dire consequences for the patient.

Could it be that doctors are afraid of the “I don’t know” option? Perhaps they are not afraid enough of the consequences. Is it pride, professional insecurity, arrogance, fear of humiliation..?

This topic was wonderfully satirized in Samuel Shem’s classic  novel on the trials and traumas of medical internship: The House of God. In the narrative things didn’t work out so well as the interns seized on the opportunity for a cop-out, but Shem’s character had a valid point.

I personally think that doctors, as a group, are driven by a desire to help and cure, which may compel them to make a proactive decision when inaction (or at least delayed action) would, in fact, have been be the safer option.

So what will it take to get doctors to 'fess up when they don’t know something? Well, I'm not afraid to admit "I don't know".

Dr John Bethell

Director, Wavelength International

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