Friday, February 19, 2010
Confidence And Doubt: The Language Of Clinician Versus Researcher
This post by Nicholas Genes, MD, PhD, originally appeared at Better Health.
There's an adage I often think about: "A physician's job requires the expression of confidence. The researcher's role is to express doubt."
This was never more apparent than when I transitioned from the research environment into the clerkships of medical school. The language of decision-making had abruptly changed. In the lab, a year's worth of experiments is summarized with "seems" and "suggests," and every assertion is carefully calibrated to acknowledge uncertainty and a high standard for proof.
As a student on clerkships, I couldn't quite wrap my head around the residents' ambitious plans for patients:
"Check CBC, electrolytes, chest X-ray, EKG, oh, and, he needs a head CT."
This use of "need" too often seemed careless to me, as if any patient could need a test that was almost certainly going to be normal, that in most parts of the world would never even be considered.
But in the residents' perspective, I came to understand the head CT was just an expected component of the patient's management. It had nothing to do with likelihood ratios or pertinent life-threatening conditions that must be explored. It was simply part of the story for certain patient scenarios, and couldn't be omitted without raising a lot of questions.
"We should also check a TSH level."
Few patients ever needed a TSH level, as far as I recall—this wasn't something that would hold up discharge, for instance. But checking thyroid function was often something that should also be done. Again, not because the residents had a firm grasp of the prevalence of thyroid disease in certain populations, but rather, because it demonstrated a thorough workup and, while not an essential or expected part of management, was nice for the attendings to see.
Over time, I gradually adjusted to this very nosocomial interpretation of "need" and "should." Now that I'm an attending, and the students' and residents' plans are a lot more hypothetical (until they get my approval), I'm hearing a little more "want" and "think" and "maybe." For me, it's a welcome return—a language more in line with my background, and one that acknowledges the uncertainties of medicine.
This post originally appeared on Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
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