Throughout my career, I have consistently conveyed to aspiring medical students that one of the most compelling aspects of being a physician is the wealth of knowledge that can cater to diverse personalities and interests.
Whether one is introspective or outgoing, detail-oriented or a visionary, a dedicated researcher or a passionate clinician, the field of medicine offers a place for everyone. Unfortunately, a small percentage of physicians eventually confront disillusionment and may leave the profession for reasons that are all too common.
The progress in medical knowledge over the years has been remarkable.
For instance, the HIV ward that once showcased severely ill patients during my training has since been closed in many affluent nations, as its services are no longer necessary. When my young neighbor suffered a stroke, medical professionals skillfully removed the clot obstructing his artery, not only saving his life but also restoring his quality of life. Additionally, an acquaintance recently donated a kidney to a sibling, enabling both individuals to maintain their lives as they were before.
In my specialty of oncology, effective treatments were once scarce. The concept of palliative care was still in its early stages, and many healthcare providers were just beginning to recognize the need for patients to have a voice in their treatment decisions, holding considerable authority in hospitals and in their patients’ lives.
Today, the entire landscape of oncology is vastly transformed.
Despite the advancements in medical understanding, my initial year as a newly qualified oncologist fell short of my expectations, and I believe subsequent years were similarly lacking. While I possessed a solid grasp of numerous facts and could competently administer chemotherapy and interpret patient results, I struggled to address the deeper, more meaningful questions posed by my patients.
Medical journals often illustrated survival statistics, but a recently divorced father wanted to know his specific position on that curve to determine how to spend his time with his children. A matriarch queried whether a median survival of 12 months meant she would “definitely” live to meet her grandchild, who was due in six months. When faced with a drug that had a low response rate but a high risk of severe side effects, should a single parent consider taking that risk?
The discouraging and silent response in my mind to such inquiries was, “I don’t know.”
Additionally, when faced with a “mixed response” in treatment outcomes, should I present the situation as half empty or half full? How could I effectively communicate to patients that statistics about others’ experiences with chemotherapy do not necessarily reflect individual outcomes? As I affixed my newly earned credentials to my notes, I envied the confidence exhibited by my colleagues, fearing I was all appearance and no substance.
I increasingly realized that the words and actions of an oncologist can have profound and life-changing implications for patients. Communicating to a patient that they may not live to see their child graduate from primary school, or that attending a wedding may only be possible if it happens immediately, is a heavy responsibility.
For me, getting this aspect of medicine right was both a significant challenge and a compelling pursuit.
While data can help make informed predictions, the inherent uncertainty must be acknowledged and communicated with courage and sensitivity. Moreover, a skilled oncologist must establish trust, which requires projecting confidence. Imagine a patient facing a serious illness being attended by a doctor who mostly mumbles, “I don’t know.” A more troubling scenario occurs when physicians express certainty without being correct.
The human body is inherently unpredictable; patients with aggressive diseases can defy expectations, while those with seemingly positive prognoses may experience setbacks. I once believed that over time, I would accumulate enough knowledge to rarely have to admit, “I don’t know.” However, after twenty-five years, I find myself saying this more frequently, as the more I learn, the less I feel “totally sure” about many aspects.
Interestingly, rather than losing confidence or questioning what it means to be a competent physician, I find that patients often appreciate this honesty.
Admitting “I don’t know” does not indicate defeat; it can be followed by a commitment to remain engaged with the patient and to share what I do know and can discover.
As medical students and trainees, we are taught that acknowledging our limitations is in the best interest of our patients. Yet, once we become licensed practitioners, we often feel pressured to present ourselves as having all the answers. A more beneficial approach would involve discarding this illusion.
While sometimes our colleagues can provide expertise to fill gaps in knowledge, there will be countless instances where we must rely on our own self-awareness and engage in honest dialogue with patients.
Like many in the medical field, I initially felt isolated in my experiences of self-doubt. It took time for me to realize that this struggle is a common but silent affliction.
Therefore, when I encountered a thoughtful essay from a newly minted radiation oncologist, I was relieved to see someone else recognize earlier than I did that saying “I don’t know” does not equate to having nothing valuable to contribute.
If the medical profession emphasized this lesson more explicitly from the beginning, our patients would undoubtedly benefit.
Ranjana Srivastava is an oncologist from Australia, an award-winning author, and a Fulbright scholar. Her latest publication is titled “Every Word Matters: Writing to Engage the Public.”
