Upon my son and daughter-in-law’s graduation from Harvard Medical School, the Dean gave the students three pieces of superb advice. The first two are fairly standard:
(1) “Be kind”
(2) “Listen to your patient”
A quick and easy way to determine whether you have a good doctor in the first ten minutes of an appointment is to see if he or she follows advice #2. Incidentally, it has been said that most doctors make up their mind in those first ten minutes, so the key question at the end of the appointment is, “What else could it be, doctor?” Then the dean’s third piece of advice to the graduating students and us proud parents, completely delighted me with its ringing truth.
(3) “Think out loud”
Openly reveal to your patients the workings of your real-time mind and show them how a doctor thinks. For example, what precisely is the present illness and what is its exact relationship to the events that are associated with it?
Through many years of thinking out loud with my patients, I developed a fourth piece of advice, which, although an outgrowth of #3, also trumps it—not only because it touches on much wider issues for everyone—but because, for a doctor, it often is of life-and-death importance. The tricky part of thinking out loud with patients is that you run the risk of displaying how little you understand about what ails them. Sometimes you encounter a collection of symptoms that, although obviously a sickness from which the patient is truly suffering, the entire field of medicine is in the dark as to what is going on and how to treat it with anything other than kindness. Perhaps, we haven’t even come up with a name for it yet. I have always loved the term for this medical ignorance: we look the patient straight in the eye and tell them with authority that they have an idiopathic condition. Long after that term, with its elegant origins in ancient Greek, was coined, somewhere a med student came up with its real definition: “The doctor’s an idiot and the patient’s pathetic.”
(4) “Know What You Do Not Know”
For starters, do not lead your patient to believe that you know more than you know. There are rare exceptions to this rule, but, infinitely more important, don’t fool yourself into believing that you know more that you know. Now we are entering into the realm of this blog’s domain, which is human nature.
Okay, I’ll give you a sneak preview of the book: both BS’ing and the appreciation of quality-BS (which, like fashion, is in a constant state of flux) has provided the motivation to progressively bind us closer together, which is at the root of our species’ worldly success. That’s it. That is all you are getting on that subject here–you have to read the book to get the whole odd-but-glorious story. Read this short excerpt.
Therefore, getting back to “knowing what you do not know,” so vitally important for a doctor, this virtue must inveigh against the one odd passion that our own species has contributed to human nature. Yet for me, the single most rewarding dimension of being a doctor was that my office was a no-BS zone. When a someone walks into a doctor’s office bearing suffering, all human pretense ceases, and all are immersed within the sublime honesty that is the gift from our noble ancestors, welling up through the mists of time.