More Noctor Nonsense

August 1, 2014

Unfortunately, this isn’t the first time this radiologist was confronted with a lack of knowledge.

So the other night, I got a call regarding one of the dozens of X-rays for tube and line placement I read in a typical shift. Well now, I thought, this is unusual - calls from clinicians during the night are usually for more complex studies, like CT. What could be the issue with this single-view exam?

Turned out the caller was a nurse, who said she needed clarification as to where a nasogastric tube was. Could I somehow have failed to mention this in my report? Embarrassed at the merest thought, I was relieved to see that this was not the case; I had stated tip was in the antrum, and pointed this out to her.

Now, there are a few things she might have done to save face and/or salvage some respect from me, assuming she cared about such things. She might have, for instance, acted momentarily surprised, and then expressed apology for not having read the report carefully enough, for there it was in black and white. She didn’t do that.

She might have said that my report’s wording was somehow confusing, or that she didn’t agree with some statement in it. She might even have tried claiming that she had called for a different reason entirely, rather than the actual one…which I daresay should have been embarrassing for anybody claiming to be an educated medical professional to admit: She didn’t know what an antrum was.

Mind you, she didn’t overtly express ignorance of the term. No, she tried verbally dancing around the matter…I think it would actually have shown greater strength of character (humility, willingness to learn, etc.) if she had said something like, “Gosh! I guess I forgot some of my anatomy, huh?” Not a chance.

I don’t think I’m quite ready to boldly declare that this constitutes a fundamental difference between the education/training physicians receive versus that of noctors (Google the term if, against all odds, you haven’t encountered it yet)…but my anecdotal evidence is mounting. This incident is not the first of its kind - that dubious distinction goes to another nurse, who not only didn’t know what the cavoatrial junction was, but semi-accused me of making up the term for a shabby report rather than consider that the fault, a la Cassius, might not be in the radiological stars.[[{"type":"media","view_mode":"media_crop","fid":"26695","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_929325853649","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2519","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 159px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":" ","typeof":"foaf:Image"}}]]

When I was in med school and especially in residency, trying to hide your ignorance was a greater sin than having it in the first place. It had potential not only to deprive you of a “teaching moment,” but even to degrade patient care. Yes, it was embarrassing not to know everything under the sun…especially given that so many doctors, aspiring and recently-minted, were perfectionists.

So, what were you supposed to do when you discovered, once again, that you were not quite omniscient? In the setting of teaching rounds, one of my best preceptors summed it up: You looked your senior in the eye, and said, “Sir, I don’t know…but I’ll know it for you tomorrow.” (Then, you actually followed through by educating yourself on the subject and being ready to knowledgably discuss it.)

Hopefully, this translated to subsequent life, when you would no longer have a supervisory type to keep you honest. Rather, you would be on the lookout for gaps in your own knowledge, and be ever-ready to correct them. Don’t know something? Educate yourself about it - before you bring your ignorance to bear on the patient. And for the sake of your colleagues’ time if not your own professional pride, if you have any doubts about your data or comprehension of same, do what you can to straighten it out before showcasing your deficiency to others on the healthcare team.

I would like to imagine, as our healthcare system seems bound and determined to replace physicians with not-physicians wherever and whenever possible, that the facilities educating and training our would-be replacements are making some effort to convey the same ethic. Otherwise, maybe this whole physician-extender thing is being a little overextended.