Things Doctors Don't Know

Sometimes patients assume we know the entire spectrum of human health and disease. But - perhaps to public consternation - there is so much that physicians do not know, and a lot of this is probably surprising. The whole of medicine is too big, too vast, too complex, and ever-changing, and doctors choose what they want to become experts in. I can tell you the steps of a heart surgery, interpret a panel of laboratory tests, or tell someone they will die, but I know very little about nutrition. When I come home during the holidays and see non-medical family and friends, I inevitably get asked about this or that diet or supplement or exercise regimen. And despite being a doctor, I have no sage counsel on these topics; the extent that anesthesia involves diet on an everyday basis is to dictate when you have to stop eating or drinking before surgery. This shocks people, but it's entirely true. I had a brilliant wonderful mentor in medical school whose interest and expertise surrounded the primary care of a bariatric patient after they had gastric bypass surgery. She could tell you every little thing about nutrition, diet, supplements, and weight loss. She could tell you what psychological barriers these patients encounter, what screening they should get for preventative medicine, and what medications, vitamins, and nutrients were absorbed from what parts of the gastrointestinal tract. I could do none of this and probably will never be able to. But that's where she's focused her medical training, and consequently, she cannot do things I do on a daily basis: placing a breathing tube, responding to a multitrauma victim of a car accident, or inserting an IV into a three month old child.

Medicine is and has to be specialized. Long gone are the days of the giants who could do everything - manage a pregnant patient, deliver a child by C-section, resuscitate that child, care for him while he grew up, operate when he developed appendicitis, and manage his chronic illnesses as he grows old. And we must know our limits. I never give advice regarding nutrition. Or psychiatric illness. Or how to raise a child. We learn about those things in medical school, but being a doctor does not automatically make us authority. We seek to learn more, carving both depth and breadth of knowledge, but we will never know everything.