Trog Blog #7: The beautiful “I don’t know”

This concept ties in well with Trog Blog #6. It’s effectively admitting to your patient that you don’t know what is going on.

What on God’s-green-earth constitutes this as a clinical pearl? Great question.

It may be that the owners, in particular this owner, is just pessimistic. Or maybe it’s because I’ve read enough literature so far (can always read more!) to know better. Or maybe it’s because I’ve firmly planted my foot in my mouth innumerous times. But in the musculoskeletal world, actually having the correct answer is less likely than we would all hope.

It can be really hard to admit that to patients. Especially in our medical system, where patients seek answers to questions/problems that they cannot manage on their own. It can also feel like you’re inept. After all, most patients think that an MRI and their previous provider have all the answers (“Ohmygosh I have the best surgeon/chiropractor/PT/massage therapist that said it’s because my SIJ is out of alignment. And they showed it to me on the x-ray!”).

But you’re fooling yourself if you think you have the right answer all the time. Admitting you don't know--I would suggest that is a sign of someone that is actually studying science, someone that is mature in their thinking and in their practice, and arguably someone that cares about patients.

“I don’t know for sure what is wrong with your shoulder… [insert clinical pearl from Trog Blog #6] but I do know that you don’t have scary things like cancer or significant instability, which means you have a good prognosis. In fact, your story is more helpful than an image (x-ray, MRI, etc) ever could be. Do you mind if we try a couple things to help your function?”

Don’t tell me that won’t get patient buy-in! Patient’s don’t want smoke blown up their you-know-whats. They want honest providers that are willing to help.

Plus if you guarantee it is or isn’t torn, I bet you’ll be discredited in 3 months when they finally do get that MRI that they didn’t need and it turns that is is or isn’t torn…

Being honest with your patient will get you more buy-in, and likely more respect, than telling them an “answer”--especially an answer that in all reality is a guess, whether you think so or not.

Don’t be afraid to say “I don’t know”. Make sure to follow it up with “but I can help you”, and don’t live in caves…