So you know
Sir, I think I’d better read up and review first before we discuss.” My mentor replied, “Okay, and let’s see what we can come up with.” We were to take part in a clinicopathologic conference, and as expected, the case presented was meant to be a more strenuous mental exercise in considering the closest differentials and hopefully arriving at the correct diagnosis. In such instances, wherein our final impression from the history, physical examination and course of the patient’s hospital stay is confirmed by pathologic findings, the sense of having figured out the puzzle adds to one’s confidence as a physician. But for those times that we are slightly or totally off the mark, it serves as a vivid reminder not only that we need to study harder, but to keep our heads down. We all have limits.
While writing this piece, I received a call from a surgeon who posed an infectious disease question, for which I could not provide an immediate answer. I had previously discussed this with a senior and close friend the day before. Years ago, she was placed in a similar situation and was asked to give clearance for a patient needing a lifesaving procedure. However, the present query was something that we did not cover, which was about the possibility that one can get infected from a needle prick. I told her to give me time to study. Reading through the level of risk of being infected from a needle stick injury, I found out it wasn’t zero, and there have been some reported cases. So, while rare in occurrence, it was possible. I called her back to fill her in on what I read.
From these vignettes, there are several takeaways. First, even if one is in the same field of specialty, there will always be a need to constantly review and carefully look at facts before engaging in a discussion. While it is true that two heads will always be better than one, it is on the background that both heads not only have sufficient expertise but have also done the necessary preparation. Learning from years of practice, exposure to similar cases, and the wisdom passed down by those who came before us all provide immeasurable benefits that can go a long way toward better patient care. Ultimately, the goal of every patient encounter is to provide the best possible cure, or at the very least, sound options.
Second, be open to queries and do not be quick to dismiss them, even if you are well-equipped or regarded as an expert on the concern raised. There are valid questions that deserve looking into, as it also has implications for the team caring for the patient. In fact, thinking about it now, the hardest ones actually do not come from colleagues but from those who are not in the medical field. Personally, I am glad that these come up because it keeps us on our toes. There are still so many questions that have no answers despite the availability of advanced diagnostics and the move toward precision medicine.
Third, don’t fall into the trap of being that person who always has something to say. If you are familiar with the word “mema”—meaning may “masabi lang” (just to have something to say)—stop and ask yourself, “Will my contribution add value, or will it serve to confuse? Will it derail the team from coming up with a sound decision?”
Fourth, if you know you have very little grasp of the situation, practice temperance. Speaking beyond what you know can be detrimental, and this not only applies to the field of medicine but to all other areas as well. Let us keep this not only in mind but close to our hearts. As the saying goes (often attributed to Stephen Hawking), “the greatest enemy of knowledge is not ignorance, it is the illusion of knowledge.” Remember that if your intended outcome is to impress, the effect is opposite—it is actually a clear giveaway of the limits of your understanding. Keep your ego and your arrogance at bay.
Fifth, it is perfectly fine to have doubts, not to the extent of immobility, but as an avenue wherein we get to know ourselves better and the areas where we can improve. It strengthens bonds and friendships, knowing that our decisions will affect not only the patient but their loved ones. Most importantly, it teaches us to strive toward nurturing and deepening our faith in God.
As each day passes, let us try to be more grateful to be in a place that constantly provides opportunities to not only be of assistance but also a chance to be both a teacher and a forever student. Let’s contribute to growth and not to unnecessary noise. We have enough of those.
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