“I don’t know” is a phrase that I labored to forget and prevent myself from uttering as a med student and resident. I was taught that allowing others to hear me say it would be detrimental to my reputation and perceived status. Patients would lose trust in me, nurses would not respect me, and senior residents and attendings would look down on me and challenge me. “Never say, ‘I Don’t Know.’” This command rang in my head repeatedly during my years in clinical settings. However, when I began performing in-home health assessments, I came to an honest and sobering conclusion: We as physicians and health care professionals do not know much, if anything, about the patients we see, and our failure to identify or accept this fact is perpetuating or causing health problems in many. We base the knowledge and recommendations we share with patients on the information we have learned, heard, or gained through our own personal experiences and education. This information pertains directly to other individuals — study participants — not our patients. I firmly believe and continue to gain more evidence to support the notion that everyone’s body is different and functions differently. Therefore, can we adequately apply guidelines and standards of care derived from acceptable studies to individuals who may share some characteristics with those in study groups? Should we make the assumption that results observed during the study period will predict those seen in our patients? Is it worth the risk? Acknowledging what’s unpredictable Even if by chance a patient happened to be part of a study that investigated a certain pharmaceutical or therapy, do we really know how the drug will affect the patient outside of the controlled research environment? We have to question possible outcomes since the patient’s medical condition will be affected by external factors and the patient may not adhere to the strict regimen provided by the researchers. Variables known and unknown to the research team will now have the opportunity to affect the patient with consequences that cannot be predicted. In light of this, I believe we have to be aware of how we present this information to patients. Instead of doctrines written in stone, such as, “You need to follow this diet,” or, “Your cancer will cause _____,” I recommend focusing on the possible risks and how they may apply to the individual patient, because exam findings and test results do not tell the whole story. We cannot honestly tell individuals what will happen to them because their unique physical make-up and lifestyles play crucial roles in their outcomes and health status, and our brief encounters with them do not provide the opportunity to gain insight in these areas. The promotion of “healthy” habits and practices is an area that needs to be addressed, as well. First and foremost, what is “healthy”? It may sound strange, but I am no longer sure what characteristics to use in order to determine the classification of healthy. We as physicians believe that the term “healthy” is one size fits all. But, do we really know this to be true? For instance, not everyone can tolerate eating fruits and vegetables. Can they then be classified as healthy? Conversely, smoking does not cause disease or ailments in every smoker. Can smoking then be classified as unhealthy? Changing views Patients ask these questions as well. Unfortunately, they often refrain from asking in the office and many times keep them to themselves until motivated to share their thoughts during a discussion of their lifestyle practices. My current experience has shown me that ignorance or lack of knowledge is not what is preventing individuals from participating in preventive care or proper health management. Often, it’s confusion and/or lack of motivation derived from the individuals’ view of the world and of themselves. For instance, if a woman uses excessive drinking to calm her nerves from the stress of work, she couldn’t care less what a physician tells her about the risks of alcohol abuse. She will willingly continue to take the risk because she believes the benefit is greater for her, especially if the health of those she drinks with has not suffered due to alcohol. To compound the issue, constant prodding by her doctors and nagging by her family and friends to quit can strengthen her resolve to continue the habit because of the frustration caused by her guilt. She knows the risks to her health but she believes she needs alcohol to maintain her sanity and counter the lack of empathy shown to her. “They don’t understand what I am going through and they don’t seem to care,” is a common refrain. Without gaining a firm understanding of the impetus of an individual’s lifestyle choices, proper intervention cannot be achieved. Simply conveying general facts and figures should not be relied upon. Motivating this patient to share why she decided to start drinking, why she continues to drink in excess, and why she believes she has been unable to stop will be more beneficial because the root cause will be identified and steps to resolve it can then be determined. Avoiding generalizations I have become keenly aware that health and healthcare cannot be generalized. How we all choose to live life and what we focus our mind on routinely dictate our daily decisions, our relationship with others and ourselves, and our customs, ultimately shaping our health status. As physicians, I believe we have to be especially mindful of this. Discussion and management of individual well-being should be an integral component of every routine patient visit and interaction. This allows us to gain valuable information about the patient that we should use to construct a treatment plan and recommendations, rather than resorting to standards based on study data. We owe it to our patients, our loved ones and ourselves to seek, utilize and embrace the importance and significance of knowledge obtained from daily life and through partnerships with one another, at least to the same degree we deem that gained from researched and printed materials. Source
