Knowing What You Don’t Know…And Embracing It

Maybe it’s because I just finished my first year of medical school a week ago, but I came to Telluride very much in a state of trying to process the whirlwind that was the previous 10 months.  I had learned so much more than I ever thought I could (and managed to forget about 10 times that much information), but what important lessons did I actually take away from that experience?  Beyond the amazing opportunities I was afforded to learn the material and begin to learn what it means to be a professional, what did I come to learn about myself?  The first thing that came to mind was that I learned my intellectual and emotional limits, but the real truth is much deeper than that, I think.  What I’m really beginning to learn (and will likely spend the rest of my life learning) is the humility that comes with accepting and embracing the multitude of things I don’t know or can’t do.

For me, medical school is about more than “slinging mud repeatedly against a wall in the hopes of getting as much to stick as possible”, as many of my professors have suggested.  Much of the learning comes in the realization that most of it can’t and won’t ever stick, no matter how much training or experience we acquire.  There is far too much to learn and understand to ever presume that we can become masters of it all, and I believe we’re meant to learn this fact just as much as we are the material itself.  Put another way, these years are meant to instill in us a lifelong sense of humility, a state of being in which our foundational assumption is that we are far from infallible and will need help our entire lives to achieve our goals.  It is a radical paradigm shift from the mentality we needed to get to this point, but that’s what I believe medical school, and the experiences we are privileged to have during this time, are meant to elicit.

Looking at the first part of my Telluride experience from this viewpoint helps me frame the goals I have for myself with regards to what I can take from these 5 days.  I’m a fairly new convert to the world of Patient Safety and Quality Improvement, having only really started to learn about them in the last few months, and then only because I chose to take an elective course on the subject at Georgetown that was open to a small handful of students.  I struggled somewhat with worrying what significant or unique perspectives I could bring, especially considering the wealth of experience and the diversity of backgrounds of the other participants.  However, even this first day has reminded me that my goal here is not to change how other people think, but rather to allow other people to change how I think.  I want to learn more about these issues and about how to communicate with others, and no staggering insights are required on my part in order to achieve these things.  I’m trying to leave behind the days of feeling as though I need to perform at a certain level or contribute a certain amount in order to prove (largely to myself, honestly) my worth.  I recognize this as part of a larger cultural issue with regards to the training of would-be physicians, even from a young age, but my reflections on this issue have thus far been much more personal.  I need to make sure I’m treating myself the right way first, before I can hope to be a part of changing the larger issues the medical profession needs to address.

Even after our first day of discussions, I have become very enthusiastic about addressing these issues, and I think it comes from a validation of the changes I have been trying to work towards in myself this year and recognizing that perhaps by changing myself, I can simultaneously effect positive change in these arenas.  A good example of this was in a discussion of the pervading culture of shame and embarrassment that surrounds students or physicians of any level asking for help, or even experiencing “going over their head” on the part of the patient or his/her family.  This perpetuates a situation where confidence, even false and unsubstantiated confidence, is valued over uncertainty and caution, and I believe it to be a key underlying factor in almost all instances where patient safety and quality of care is compromised.  What is the solution to this?  Clearly there is no magic bullet, but one thing that can go a long way, and is almost elegant in its simplicity, is humility.  Humility is required on the part of the medical professional to recognize his or her limitations, to accept and embrace that there are things he or she doesn’t know.  Humility means having the courage to swallow your pride and recalibrate your mindset of needing to be the problem-solver, the one with all the answers, the sole protector of a patient.  Humility allows you to take your resting pulse when you enter a room, recognize what you do and don’t know, and use the most efficient way possible to find out; namely, from those who do and have been there (nurses, residents, students, family members, the patient).

The ideal is to create a culture in which we celebrate not what others do know, but rather their ability to accept and communicate what they don’t know.  I believe this has to start from within.  If I can free myself from the paralysis of placing such huge burdens squarely on my own shoulders, of feeling like the outcomes rest entirely in my own hands,  I can take advantage of all the resources (read: people) available to actually effect change and meet not my goals, but the patient’s.  This does require a large amount of courage, since these sorts of ideas are still largely counter-cultural and there is great potential for scorn and ridicule.  However, I feel empowered by the realization that this is entirely within my control.  I can choose to find the courage to accept being wrong, to accept being a necessary but not sufficient part of my patients’ care, to weather the criticism and lack of understanding I may experience by acting this way.  I have the power to change myself, and in so doing take a small step that will solve nothing on its own, but without which a solution to the issues of patient safety and quality can never be reached.

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