Thread by @gradydoctor

1/
I was rounding with my team recently and you were our new patient. A student had presented your case at the bedside. You listened intently and offered corrections where needed. After examining you, I paused and twisted my mouth under my mask.

I narrowed my eyes.

2/
This didn’t make sense to me. And to be clear— it may very well have made sense to someone else.

Just not me.

You: “You alright over there, doc? Look like your wheels turning hard.”

*laughter*

Me: “You got me. Yeah, I’m just trying to put this all together.”

Hmmm.

3/
Like, your physical exam fit the story. And part of your lab tests and imaging aligned with the leading diagnosis. But then there was this other part of your blood work that threw a curveball.

Hmmm.

And so. I told you and my team exactly that.

Yup.

4/
Me: “Sometimes patients come in and we know exactly what’s going on. The story, exam, labs, and all of it point to an answer. But a lot of times, there are parts we need to go look up or talk to other colleagues about. I think that’s where I am right now.”

*silence*

5/
You: “What part is throwing you off?”
Me: “Honestly? It’s a few things.”

And you listened as I told you about my illness script & how you had stuff that didn’t fit it. Then I walked through my diagnostic schema & badly wished I had @rabihmgeha in my pocket.

Alas, I did not.

6/
Me: “So when I leave you, I’m gonna go and read some stuff. Because it might be that this fits what we thought but that I just have a gap in my knowledge where I didn’t know that part.”

I watched my team watching you. To see if you’d get nervous or upset.

You did not.

7/
You: “That’s what’s up.”
Me: “Huh?”
You: “I like that you thinking & you ain’t fronting like you know everything!”

*laughter*

You: “I’m for real! ‘Cause then you focused more on YOU than ME out here trying to flex.”

That made us all laugh again. But you weren’t joking.

8/
The student chimed in and said they’d searched the question already and didn’t find much.

Me: “Okay. I’m gonna check a couple more things. But in the meantime, let’s go ahead and call that consult.”

The student nodded.

You: “What’s that mean?”

9/
Me: “It’s when we call in experts who focus on this part of the body all day every day.”
You: “Yeah, call ‘em. They might roll up and say, ‘Oh yeeeeeeah. This is so-and-so.’”
Me: “Real talk though? You right.”

*laughter*

And that was pretty much where we left it.

10/
I read over lunch & learned some stuff. And then our colleagues came in, looked at you, and said:

“Oh yeeeeeah. This is so-and-so.”

Ha.

But that was fine because they had seen a lot more cases of so-and-so than me. So that, plus their recommendations, helped a lot.

Yup.

11/
It’s the start of a new academic year. Which means new residents and new fellows and new attendings. And some of the best advice I have to give is to have the courage to admit to uncertainty.

Because it’s not patient-centered to front like you know everything.

Nope.

12/
Also.

Since the #hiddencurriculum is alive & well, explicitly normalizing being unsure is a teachable moment.

Wait.

Unsure—but urgently curious. At the same time.

It took me over 20 years to feel okay admitting to knowledge gaps —especially with patients.

Yup.

13/
But what I now know is that just like our patients want us to humanize them, that goes both ways. And no human knows everything.

Nope.

Okay, maybe @Gurpreet2015 does.

Ha.

Though I assure you he’d argue that it’s urgent curiosity more than anything else.

Mmm hmm.

14/
Whelp. Let me stop here and do some reading. Because you never know when a classic case of so-and-so might be right around the corner.

And remember—everything you do know you once didn’t know. Okay?

💛

#humanismalways
#lifelonglearner