Description
What we don’t know
What we don’t know Medicine changes all the time and it is the responsibility of every doctor to ensure that their professional repertoire remains within the bounds of satisfactory practice. This does not mean that we should espouse every new development, but how do we know what is acceptable? In particular where do the boundaries of acceptable knowledge lie?
If our favourite drug is no longer to be found in the pharmacopoeia it is clear that we should wonder if we are getting out of date. The trouble lies not with what we don’t know, but with that we don’t know what we don’t know. Few clinicians specifically keep abreast with developments outside their field and from time to time these developments spill over into the clinical tasks of anaesthesia. This suddenly confronts the practitioner with the task not just of learning about the immediate issue but also of understanding the background. This sort of problem is not restricted to ageing consultants. As a medical student I (DG) learned about alpha and beta globulins. The whole of immunology could be taught in three or four afternoons. Not more than five years later I read an article about allergic reactions to anaesthetic agents and it dawned on me that I did not understand any of the terms being used. Modern immunology had been born whilst I wasn’t looking. Catching up required me to relearn some basic science. The only certain thing about change is that there’s more of it about all the time. So how are we to find out what we don’t know we don’t know. I (SB) used to know all the ACE inhibitors and Beta Blockers for use in cardiology, now I have to look all the new names up in the BNF and try to keep up to date as to whether they really are all the same in our post MI patients.
I suspect it is not as difficult as we sometimes assume. The titles and summaries in the BMJ and the Lancet for instance might give us a clue. An article that we expect to cover familiar ground sounds strange. In the department or coffee room we hear a clinical discussion that doesn’t sound familiar. I suspect that what stands in the way of keeping up to date is something much more human. In the first place we need to admit to ourselves and often to our colleagues that we have fallen behind. Doctors are never keen to admit that they are not in control. Secondly, having recognised a deficiency we need to act upon this recognition. The road to hell may or may not be paved with good intentions. My bedside table is deep in articles that I intend to read and probably never will! In future we need to keep a record of the gaps in our knowledge and plan how to fill them. The portfolio is the best place to record these and to note down our intentions. At least we will then have the following years appraisal to jog our memory and move us forward from intention to action.
