Do you know (and admit) what you don't know?

[SpecialK]

Hi all,

I was reading a medically unrelated article today which described the Dunning-Kruger Effect, a cognitive bias rendering some people to believe they possess greater knowledge or skill in a particular area than they do, and/or the inability to recognise same.

This got me thinking about how this applies to clinical personnel (including, but not specific to, ambulance personnel) and the implications this can have on patient safety.

I have noticed some people are not as willing to admit when they don't know something, they have an attitude of "I know everything" or "I am sure it is X" (when it's obviously not) or are paralysed with fear from being honest with their patients, or are really hesitant to look at the CPGs in front of a patient. Now, these are the minority, but it strikes me as potentially very dangerous for the patient.

I am very happy and comfortable saying to a patient "I don't know what is wrong with you" or say "I just need to look in the manual (CPGs)" or "I'm really not sure what is best for you, let me go to the kitchen and use the phone to have a word to your GP (or the Clinical Support Desk)". I will always admit when I do not know something or am not sure, particularly if it could have a negative effect on the patient.

For example, I know little about assessing and treating sick children. I can do a basic assessment and treat clinically obvious problems (such as giving adrenaline for anaphylaxis) but am heavily reliant upon the guidance and notes in the CPGs. I am loathe to recommend other than non-immediate referral to a GP, midwife or ED (as appropriate) for other than minor problems because I am honest and willing to admit I simply do not possess the clinical expertise in this area.

 

[mgr22]

I think what you're describing exists everywhere, but can be particularly dangerous in medicine. Having a healthy respect for the breadth of the field and acknowledging the impossibility of knowing enough to diagnose and treat every complaint should be no-brainers, but egos and biases sometimes get in the way. A book that addresses this fairly well is How Doctors Think by Jerome Groopman, MD. Groopman highlights the dangers of diagnosing based primarily on experiential biases, and failing to consider more than one cause of presenting problems. Those are certainly issues for medics, too; it's natural to compare what you're seeing in the field to what you've already seen, before beginning to consider less-familiar scenarios.

That line from Dirty Harry about "A man's got to know his limitations" is a good place to start, I think. I admire practitioners who have a healthy respect for what they don't know, and are more likely to admit their uncertainty about a presenting problem than to contrive a diagnosis from their necessarily limited experience. When my primary-care physician tells me he's not sure what's causing a medical problem, and suggests steps to narrow the possibilities, I feel better than if he'd named only one possible cause for my complaint.