How Much Do Doctors Really Know?

The short answer is, a lot, if it’s about something they deal with every day. Or something they’ve personally encountered or suffered from, or otherwise have a passion about (for example, my professor on ankylosing spondylitis, actually had?ankylosing spondylitis). So, count one passion, a few health events in their immediate circle, and a few dozen common ailments in their specialty.

? Aside from these, there’s going to be a varying amount of readily-available data in your physician’s mental rolodex, and it’s going to vary from doctor to doctor. To understand why that is, let’s have a look at the process of medical education, at least where I went to school:

? I spent the first year of med school learning how things are supposed to work: the functioning of a normal healthy body. The second year was focused on the ways things can go wrong. Keep in mind, there are?tens of thousands?of ways things can go wrong, so conditions that were studied were chosen partly due to being common, and partly due to being very illustrative of particular abnormal processes (I think this is why every licensing exam seemed to have questions about pheochromocytomas, despite the fact that anyone besides an endocrinologist would be lucky to actually see one even once in their lifetime).

? The next two years were spent doing clinical rotations. Every month we would do time in a different specialty, this month orthopedics, next month dermatology, then neurosurgery – you get the idea. What you would learn there was?very?highly dependent on what cases happened to come in during the time you were on service. Granted the attending physicians would give us assignments to research and report on, to teach us things that didn’t come up during our rotation, but the stuff that would really stick with you was the stuff you actually saw.

? Then comes residency – on-the-job training in one’s chosen specialty. For Family Practice, it’s a lot like med school, with a different service every month, because we’re generalists and need to know something about everything. As a matter of fact, a couple of years after graduation I ran into a former classmate, and while we were chatting (if I recall correctly she had gone into Hematology) she admitted she had initially thought about going into FP but in the end had decided there was just ‘too much to know’!

? Then you get out into clinical practice and start seeing what’s really out there. You get good at the stuff you see every day, of course, but I for one am glad I found myself practicing in rural areas. A rural FP will see off-the-wall conditions not seen elsewhere, just because they’re the only resource around.

? Now the key point here is, what about the odd stuff? Everyone has seen movies where a doctor is confronted with something really weird and they have to hit the lab. In reality, not all of us are skilled researchers and most of us don’t have a lab to go to, or the time to spend in it, but it makes a convenient plot shortcut for a screenwriter (plus it looks cool). The important thing is that they know that they don’t know, but they also know they need to find out – and how to do that.

? After I had been in the Army for a few years I was shipped off to the Primary Leadership Development School. This was the first step in education for non-commissioned officers and all the tests were open-book. This might tempt some to crack jokes about the average intelligence level of an NCO, but let me tell you that among the thirty or so guys in my scout platoon in the Guard, we had an IT engineer, a high-school math teacher, a high-school principal, a pre-law student, a police officer, and me, who was pre-med. The tests were open book because the cadre were reinforcing the point that you weren’t expected to know everything, but you were supposed to know where to find it.

? That’s an attitude that has carried me through a lot of my practice. It’s impossible to know everything there is to know. There are literally thousands of research papers published every year. Let’s face it, a century and a half ago medical knowledge was a lot more scant (there’s a meme going around about how back then a woman seeking treatment for depression was liable to get a dose of cocaine and a session with a vibrator, and there’s a certain amount of truth to that!). A smart doc knows the limits of their knowledge and has the references to look things up when they reach that boundary. One of the things I was taught was that, if you were stepping into the exam room to have a look at something you weren’t familiar with, you first took a few minutes to review your sources and have a quick brush-up. This isn’t a sign of intellectual deficiency. It’s an honest understanding of one’s own shortcomings and a willingness to work to overcome them. We were taught enough to function, and we were then taught to learn from our patients.?And keep your books handy!

? So don’t be dismayed if your doctor gets that momentary look of confusion on their face when you tell them something. You only need to be dismayed if they don’t do something about it.