Trainee-Authored Letters to the Editor
Delving into these details may require
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trust nor rapport with our patient. He of seeing their physician come through the
longer conversations, but ultimately, they
can enhance patient–doctor relationships.
Through such conversations, doctors begin
to hear and fully acknowledge so-called
“difficult” or “noncompliant” patients.
Training future doctors to use the teach-
back method consistently during patient
counseling empowers patients with a clear
understanding of their treatment plans.
Threading course work that addresses
issues of cultural competence, social
determinants of health, and empathy
throughout not only medical school but
also residency reiterates the foundations
of trust as a basis of medicine.
Disclosures: None reported.
Nneka I. Ogbutor
Third-year medical student, City University of New
York School of Medicine, New York, New York;
nogbuto000@citymail.cuny.edu.
First published online January 14, 2019
The Three Most Feared Words
in Medicine
To the Editor: Oftentimes, the thing
we ought to do is the thing we are most
afraid of doing. In medicine, at all
levels of training, there is perhaps no
phrase more feared than “I don’t know.”
For many medical students these three
words mean not studious enough, not
smart enough, or not prepared enough.
I believe that our inability to be
transparent about what we do not know
breaks down the trust between ourselves
and our peers, instructors, and patients.
One recent interaction with a patient
aptly demonstrated this breakdown of
trust. The elderly patient was admitted
to receive intravenous antibiotics for
uncomplicated diverticulitis. He believed
that complications from an inguinal
hernia repair caused the diverticulitis.
He was infuriated over the hospital
admission and blamed his surgeon for the
“botched” procedure.
Instead of listening to his concerns and
perspective, our team eagerly explained
everything we knew about diverticulitis
and its risk factors. We confidently
explained that his diverticulosis was most
likely related to his advanced age and low-
fiber diet. This “education” built neither
Academic Medicine, Vol. 94, No. 4 / April 2019
remained suspicious of our advice for
the remainder of his hospitalization and
worried that our interventions would
cause further complications.
No studies demonstrate a causal
relationship between inguinal hernia
repairs and diverticulosis/diverticulitis;
however, saying, simply, “I don’t know,” in
response to the patient’s hypothesis would
have been reasonable. I think this simple
acknowledgment would have put the patient
at ease. Perhaps he would have believed
that we were listening, rather than trying to
defend the hospital and the surgeon.
To build trust with our peers, instructors,
and patients, we must admit what we do
not know. Only then will others trust us
when we actually do have the answer.
Solving the problem of eroded trust
involves changing the culture of
medicine. When a preceptor on rounds
asks a question of a learner who does
not know the answer, the first instinct
might be to view this as a failure. Medical
students and all learners should resist
this negative thought. Instead, we should
write down the question and research the
answer later. Soon enough, these three
words will simply be a reminder of the
incredible opportunity we all have to
learn and grow every day.
Disclosures: The views and the opinions expressed
herein are those of the author and do not
necessarily reflect the policy or official position
of the Uniformed Services University or the
Department of Defense.
Matthew Horch
Third-year medical student, Uniformed Services
University of the Health Sciences, Bethesda,
Maryland; matthew.horch@usuhs.edu.
First published online January 8, 2019
Repaying a Patient’s Trust
To the Editor: “Hi, my name is Scott,
and I’m a third-year medical student (and
I have no idea what I’m doing).” I say these
words over and over during the day, except
for the part about how I do not actually
know much—I only think that to myself.
I am currently doing the outpatient
portion of a longitudinal clerkship, so
every day I see the patients of community
physicians who have long, established
relationships with their patients. Instead
door, many now see me.
Imagine, if you will, getting onto your
next flight and being informed by the
overhead voice that a student, not even
graduated from flight school, will be
piloting the aircraft. I would get off the
plane in the blink of an eye. Yet, patients
place that same kind of faith in medical
students every day. They firmly believe
the risk they are taking will help us
students develop into competent and
compassionate physicians. They believe
that I will study hard, learn from them,
and take care not to burn out before I can
one day take care of them on my own.
Burnout rates among medical students
have been as high as 50% in the last
decade, and 10% of students experience
suicidal ideation.1 A patient recently told
me that she had read an article online
about rates of physician suicide, and she
gently reminded me to do the best I can
with my studies, but also to remember
to eat well, sleep, and get enough time to
relax apart from school. I sat there, feeling
utterly inadequate; the recommendations
I was just about to give regarding lifestyle
and diet suddenly seemed silly. As a
medical student, I am conditioned to
educate patients, and I felt disoriented
being on the other side of the equation.
Every single word she said was true, and
she reminded me that we owe it to our
patients, the same ones whom we advise
to eat more vegetables and exercise more,
to listen to their words as well.
That patient trusted me with her health,
time, and wisdom. She and other patients
trust that the extra hour they spend at the
office will result in new, caring, competent
physicians. As medical students, we owe it
to our patients to make sure we do all we
can to prevent burnout so that we can one
day repay that trust.
Disclosures: None reported.
Shuyang (Scott) Liu
Third-year medical student, University of Hawaiʻi at
Manoa John A. Burns School of Medicine, Honolulu,
Hawaiʻi; sliu7@hawaii.edu; ORCID: https://orcid.
org/0000-0003-0741-1796.
First published online January 14, 2019
Reference
1 Dyrbye LN, Thomas MR, Massie FS, et al.
Burnout and suicidal ideation among
U.S. medical students. Ann Intern Med.
2008;149:334–341.
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