Being 'wrong' is a complex situation, especially for doctors

If you hate being wrong, imagine how I feel. I dislike being wrong 100 times worse. If I mess up, not only do I look bad, I worry I'm going to hurt someone. There are at least three different ways doctors get it wrong. There is the "I don't know," the "I think I know but I really don't" and finally the "I know because they told me, and they were wrong."

This last one is where initial medical thinking says stuff like, "You should take hormonal replacement therapy for your menopausal symptoms" only to discover that was not such a good idea after all. Medicine's bad.

Research science take-backs and medical mulligans happen all the time. Medical discoveries, like archaeology, unearth new "truths" all the time, only to find a few layers of dirt further down that the first conclusions were wrong. One of the most infamous was the fairly indelicate surgical approach to mental illness, the frontal lobotomy. Adding to the blunder, Antonio Moniz won the Nobel Prize in 1949 for medicine for his discovery of the therapeutic value of leucotomy in certain psychoses. In retrospect, it could be said that the judges were either so eager to assist the sick of mind they were blinded by the truth, or they themselves had volunteered for the procedure. Today billions of dollars are awarded when much-heralded therapies go awry. Vioxx was the poster child of a new class of medicines until a few people started dropping dead while taking the drug. Talk about a tough pill to swallow.

In retrospect, if I were a doctor prescribing this former wonder drug, I would have been wrong. But that counts as one of those "I was wrong, but so was everyone else." Unfortunately, that is only slight conciliation when you are telling the family the treatment was a success but the patient died.

The other wrong that I personally dread — because it is so obvious — is the plain "I don't know." It happens all the time, but it is especially hard when I believe that, as a doctor, I am supposed to know everything. My partner had a patient with a pretty awful looking rash. It was the kind of skin reaction that wasn't going to kill the kid, but not knowing what it was, I could only suggest to the mother that she dress him in long sleeves, turtleneck and ski mask. I just stared at the big red splotches and spots and had no clue. I could think what it wasn't, but what it was escaped me. I hate that. If I am supposed to know everything, then not knowing something completely destroys any fragment of professional confidence. Sure, there are specialists and really smart doctors we can call upon for their help, but not knowing adds insult to me and injury to the patient. When people pray for "the sick and the inflicted," the latter is me when I can't diagnose the former.