By Erika Sullivan, MD
Being a family doctor is a lot like being a general contractor: you’ve got to know about all the systems that make a home or a building operational and then coordinate the necessary professionals to get the job of building or renovating the home done on budget and in a timely fashion. However, inherent in this profession is the fundamental truth that you can’t know everything, every time for everyone. Invariably you’re going to reach your limitations and you will need to reach out to another professional to help sort things out. In my limited experience as a family doctor I have found that knowing the boundaries of my knowledge has become easier and easier to accept, whereas, when I was in college (or graduate school or residency…) I always struggled when I came to the borders of my knowledge and was frustrated with myself when I didn’t know the right answer.
Perhaps this comfort with not knowing everything comes with age, or perhaps from having kids. Or maybe it just happens so often in medicine that you just get used to it because you have to. Either way, I find that I’m not as scared of the unknown as I used to be. Don’t get me wrong, I still panic sometimes when I have a patient with unexplained weight loss that I am missing some terrible diagnosis, but I think that one of the things that residency and medicine has taught me is that I’ve learned how to learn, and so when I don’t know what to do I generally know who to ask or where to look it up.
I also think that part of this comfort with uncertainty comes from working closely with residents and other learners, since I constantly have to answer questions, and when I don’t know the answer to one of their questions I try to model the behavior of looking it up. In fact, this is one of the things that I like most about my job. Being around learners keeps me on my toes and pushes me to expand my horizons about new medicines, new treatments, new protocols along with just remembering the old stuff that I’ve forgotten!
Working with residents is definitely one of the highlights of my current position, but it also comes with its own set of challenges, chiefly among them is that you have to let residents (and patients and people in general) make their own decisions, even if they are bad ones. I am often reminded of one of my favorite quotations, from the author T. H. White: “The most difficult thing in the world is to know how to do a thing, and to watch someone else do it wrong without comment.” This can be particularly challenging as an educator, especially for someone like me who is a bit OCD (read: *a lot* OCD) and somewhat of a control freak, but I’ve found that this advice is more relevant than ever before. Allowing patients and students and other learners to make mistakes is how we all grow and learn and change. Like the contractor who has to let the carpenter do his work and the plumber do her work, family doctors have to learn to love (or at least live with) the decisions that other people make. But you also have to learn to live with the decisions that you make – right or wrong, good or bad – you can’t know it all, and knowing that, is half the battle.
Erika Sullivan, MD is an Assistant Clinical Professor in the Division of Family Medicine at the University of Utah School of Medicine.
Family Medicine Vital Signs 