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Trainee-Authored Letters to the Editor

The Three Most Feared Words in Medicine

Horch, Matthew

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doi: 10.1097/ACM.0000000000002586
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To the Editor:

Oftentimes, the thing we ought to do is the thing we are most afraid of doing. In medicine, at all levels of training, there is perhaps no phrase more feared than “I don’t know.” For many medical students these three words mean not studious enough, not smart enough, or not prepared enough.

I believe that our inability to be transparent about what we do not know breaks down the trust between ourselves and our peers, instructors, and patients.

One recent interaction with a patient aptly demonstrated this breakdown of trust. The elderly patient was admitted to receive intravenous antibiotics for uncomplicated diverticulitis. He believed that complications from an inguinal hernia repair caused the diverticulitis. He was infuriated over the hospital admission and blamed his surgeon for the “botched” procedure.

Instead of listening to his concerns and perspective, our team eagerly explained everything we knew about diverticulitis and its risk factors. We confidently explained that his diverticulosis was most likely related to his advanced age and low-fiber diet. This “education” built neither trust nor rapport with our patient. He remained suspicious of our advice for the remainder of his hospitalization and worried that our interventions would cause further complications.

No studies demonstrate a causal relationship between inguinal hernia repairs and diverticulosis/diverticulitis; however, saying, simply, “I don’t know,” in response to the patient’s hypothesis would have been reasonable. I think this simple acknowledgment would have put the patient at ease. Perhaps he would have believed that we were listening, rather than trying to defend the hospital and the surgeon.

To build trust with our peers, instructors, and patients, we must admit what we do not know. Only then will others trust us when we actually do have the answer.

Solving the problem of eroded trust involves changing the culture of medicine. When a preceptor on rounds asks a question of a learner who does not know the answer, the first instinct might be to view this as a failure. Medical students and all learners should resist this negative thought. Instead, we should write down the question and research the answer later. Soon enough, these three words will simply be a reminder of the incredible opportunity we all have to learn and grow every day.

Matthew Horch
Third-year medical student, Uniformed Services University of the Health Sciences, Bethesda, Maryland; [email protected]

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