Don't Believe What You're Told

 


What do you do when 2 senior doctors have differing views on a particular topic?

A) Go with the doctor who looks older.

B) Go with the doctor with more degrees to his name.

C) It doesn't matter to me because I'm a junior doctor.

D) Go review the literature for yourself and draw your own conclusions.

If your natural inclination was anything other than option D, I'm afraid your education has failed you. 

Taking things at face value

I recently had one of my juniors tell me that a big reason for coronavirus spread was via hair and feet. When I asked for a reference (since I hadn't read anything like that), I was told "That's what the doctor here told me so it must be true". There were no replies after that. 

One must always find a balance between being a skeptic and having an open mind. I searched for any evidence to support this claim and have not been able to find anything special thus far (anyone reading is free to point me to any evidence backing this up). Perhaps my junior misinterpreted what the doctor had said. Perhaps it was taken out of context. Or perhaps he was just plain wrong. 


One of the best life lessons I learnt in medical college was to not trust anything on face value. You need to develop the habit of verifying everything for yourself. Just because something sounds smart, doesn't mean it is smart. 

For example, only last month I was scolded by a senior colleague for giving Ringer Lactate to a patient with AKI. The idea that RL is bad in renal failure is a myth that has been passed down from generations. Not only is this not true but the thing they recommend instead, normal saline, is actually more likely to lead to complications. 

 https://emcrit.org/pulmcrit/myth-busting-lactated-ringers-is-safe-in-hyperkalemia-and-is-superior-to-ns/

 



Old habits die hard

The reason why this happens is because once you learn an outdated practice, it is very difficult to unlearn it. This is especially true if you've been practicing that way for several years. Perhaps it is because we feel guilty that we were unable to provide the best possible care all this while. So we go into this denial mode or even rationalize that it is not feasible to change practice (when it actually is). Unless you've been trained to adapt your practice to new information, you'll always be at risk of being outdated. 

My first lesson that I should not blindly accept anything that a senior colleague tells me occured in my first month of house surgeoncy. It was Dengue season and hospitals were being overwhelmed, so we were being posted in government hospitals on a temporary basis. I was told to start Doxycycline empirically for any patient with a fever in order to cover for typhoid. 

It was a few months later that I learnt that Doxy is a crap drug for typhoid. It is also not doing anything for Dengue. Instead, Doxy is something we give when we suspect Leptospirosis. Unfortunately, many doctors get into the habit of doing what they're told, taking things at face value and blindly accepting these kinds of "pearls". 


Mindset is as important as knowledge

Medicine is as much about attitude as it is about knowledge and skill. If the Covid pandemic has taught us anything, it's that we need to be able to adapt rapidly to not just new situations but also to new knowledge. Evidence-based medicine is what we pride ourselves on but that evidence is often not destined to remain the same forever. The sooner we learn to accept this, the better we can become as doctors. 

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