Knowing vs Knowing How to Know

There’s something very exciting about MedCrunch’s new tagline: Hacking Health. It speaks to many elements about the field of medicine and this magazine’s role in it. In a conversation with a med school classmate this morning we discussed an attending physician he worked with who really impressed him. This particular attending no doubt was brilliant. He asked my classmate lots of questions about his patients to make relevant teaching points. He expected presentations to be organized and concise. He wanted a complete differential for what the patient’s diagnosis may be and a discussion of the points going for and against each possibility. He was willing to teach you the things you didn’t know and was able to explain it clearly. He was everything you’d expect an attending physican to be in regards to his ability to be both a great clinician and teacher. I’ve had the experience of working with many people who have fit this build. From the student perspective, the experience of learning medicine is that more fulfilling with inspiring leaders as such.

Our discussion about this particular attending was caught on one point however. While my classmate insisted that this guy was just brilliant and knew everything, he implied somehow that it was by magic. One of the most important points I heard during my clinical rotations was from an internal medicine attending who reminded me a lot of the one my friend described. After a very rare disease was presented at a conference, he made a pointed joke about how in medicine we often pretend that we know all the information about even the random diseases from memory but it’s just not true. He insisted that even at his level, he often relied on looking up information from somewhere: a book or the internet perhaps. It’s not magic at all, but learning that comes over time in order to understand what to look for and how to approach a patient. The more senior physicians have had more training, more experience that the knowledge sticks. It’s not as if my classmate’s attending emerged from the womb knowing the differential for all the diseases he would encounter. He trained — just as we are doing now.

This brings me back to the idea of Hacking Health and the concepts it embodies. As physicians, knowledge is obtained over a long time period. During that time the amount of possible knowledge grows too. It’s important to have the right balance between knowing the basics, knowing what you don’t know, and knowing how to use tools to gather the information you need. Despite how much medicine has changed and grown over the last century, we are still required to sit for 8 hr computer exams which ask us to recall possibly anything ever learned about medicine and apply to multiple choice questions. The reality is that patients, social situations and medical challenges are complex and sometimes require finding out information on the fly. The best physicians moving forward will be those who have: an adequate memory, strong problem solving skills, excellent professional and interpersonal skills and the ability to leverage technology to make information easy to apply to patient care.

Photo Credit: Reigh LeBlanc