Exploring The Leadership Potential of Three Little Words: Applying “I Don’t Know” To Medicine

Recently I read an interesting article on leadership published at Inc.com.  Although most of the journal is focused on those in business, many of the pieces on leadership are very applicable to those of us in Medicine.  In this article author Curt Hanke writes about the inspiration and leadership positives found in the three simple words:  “I Don’t Know.”   On first blush, we may think that a leader speaking these words may no longer inspire confidence and may lose the support of his or her troops.  However, as Mr Hanke goes on to detail, the words “I Don’t Know” may provide inspiration and motivate teams to perform even better.

As physicians, we are leaders–we lead teams, we lead students and other trainees, and most importantly we lead patients.  There are times when we lead and guide patients and families on very challenging journeys through brutal, sometimes devastating diseases.  Often, being a good leader is the most important part of our job.  With leadership comes many responsibilities– and those whom we lead look to us to show confidence as we provide guidance in uncertain times.

As physicians are leadership roles are two fold:

1. We lead teams of caregivers with a common goal–the best outcome for our patients.  Our teams look to us for confident judgements during crisis (such as during a code blue) and guidance when making day to day clinical decisions.  Our teams are bright and capable.  Our team members are diverse both in training, ability and in education–nurses, physical therapists, pharmacists and other physicians–all working in concert to achieve clinical success.

2. We lead patients and families.  We are the experts in a complex field that is foreign to many–we are relied on as guides, as advisors as well as generals on the field of battle.  We must inspire confidence and show kindness at all times.  Our patients are often frightened and uncertain.  We must help them learn, grow and adapt to changing medical and clinical scenarios.

To lead in this way can be very challenging but is not terribly dissimilar from leading in the business world.  We must be prepared–with knowledge of disease and the best available therapies.  We must be aware of the strengths and weaknesses of each individual on our medical team (including our own) and we must be able to motivate those in very different roles to band together for common good.  We must lead patients and families with compassion–we must understand things from their perspective and apply their needs into the equations we use to make clinical decisions.  We must lead both groups with honesty.  We must be willing to say “I Don’t Know” when appropriate.

Then we must harness the power of “I Don’t Know” in four distinct ways (according to Mr Henke):

1. Creates Possibilities--As a leader, saying “I Don’t Know” in medicine, may create an opportunity to bond with patients, families and team members.  Having the courage to articulate your shortcomings as the leader may actually garner more respect and tighten bonds through your honesty.

2. Inspires Engagement–As a leader, saying “I Don’t Know” in medicine may provide opportunities for others to take center stage and bring forward ideas that they may have otherwise kept to themselves.  It allows others to think more creatively and inspires team members to find “ownership” in working to solve a particular clinical mystery or treatment problem.

3. Avoids Complacency–As a leader, saying “I Don’t Know” in medicine provides me with the motivation to learn more and to be better.  Not knowing the answer right away drives me to reflect on my particular skill set and take stock in what I can do better both as a leader and as a team member.  When the leader works to improve, it often inspires growth among team members as well.

4.  Inspires “Fun” During Difficult Times–As a leader, saying “I Don’t Know” rather than a positive effect on morale–A culture of “I Don’t Know” produces engaged team members and these engaged team members are more productive.  Ultimately a more productive medical team results in more positive patient outcomes.

Effective leadership is vital to success in both business and in medicine.  The most effective leaders know their own limitations and are not afraid to share that with the team that is inspired to follow them.  Courage to say “I Don’t Know” may be the difference in discovering the most accurate diagnosis and prescribing the most effective treatment plan for a patient and their family.  Be willing to admit when you fall short–as Socrates stated “The only true wisdom is in knowing [what] you don’t know”


28 responses to “Exploring The Leadership Potential of Three Little Words: Applying “I Don’t Know” To Medicine

  1. ” I don’t know ” The three most important words in medicine, it can be followed up with ” but I will find out”

    • Dr Knight,
      Thanks so much for taking the time to ready my blog. Your comment is spot on! The doctor who can take it a step further and “find out” is the one I want on my team!

  2. I’m leaving a doctor that was unable to say, “I don’t know.” He pretended to know, by denying my condition- acute strep throat for 3 months. Because his mind was closed, he wouldn’t listen to the reasons that the radiologist had for my sore throat not being caused by radiation. I was told that I had chronic conditions that I needed to learn to live with. I finally found an 80 year-old doctor, Urgent Care, that practiced MED 101: sore throat complaint = strep test. Then my hypothyroidism was out of range for 6 months. His reasoning was that radiation treatment would cause my thyroid to bounce around. I love electronic charts, because I was able to send him a message that my body couldn’t take hypothyroidism anymore, and the nurses were making comments about my dry skin.

    My body and my mind has been paying a terrible price-sleeping over 12 hours a day, worrying if the strep and/or hypothyroidism caused heart or other damage, the pain in all of my body, the constant fever, beginning to wonder if my mind-spirit was failing me. In all fairness, I’ve had atypical strep-and I’ve been tested twice to see if I was a strep carrier. He decided that was a confabulation to get attention. I had an infection problem, not a cancer or mental problem.

    He had been a good and caring doctor, but something happened to him this spring. I don’t know if the cancer overwhelmed him, if he has health problems of his own, or if he was having personal problems. If he didn’t want to care for me- there’s a thing called a “referral” or a letter saying that he can no longer care for me because he doesn’t know or he’s reducing his patient load-whatever.

    About the cancer-he takes care of diabetics–both conditions maim and kill..

  3. To me, uncertainty is the mark of maturity in a doctor. I remember asking my wife’s renowned vascular surgeon what he planned to do with the unburst fusiform aneurysm along her right cerebral artery when she went in for surgery: would he coil it, clip it, what? He said, “I don’t know. I won’t know until I get in there.” The answer was a relief to me (if not my wife) because it exuded confidence and a willingness to adapt to things as they occurred. In the end, he excised the entire aneurysm and sewed the arterial ends together in a masterful display of skill, and she made a full recovery.

    • Dear Mr Bonander,
      thanks so much for taking time to read my blog and to leave an important comment. I very much agree with your point–when a doctor knows his or her limitations and knows when to ask for help–that is true professional maturity. I am happy that your loved one received such excellent care.
      Best regards

  4. Geni A Bennetts, MD

    This commentary is cogent and makes an extremely excellent point. My love of medicine in part exists because it is impossible to know everything and there is always something new to learn. Having said all of this, and believed it throughout my career, I had to smile as I read this. My friends and family have teased me and called me “Dr. I-don’t-know” during all the year of my wonderful career! I have always considered the most important thing is to know where to find the answers and correct information, not knowing it all!

    • Dr Bennetts,
      Thanks so much for your thoughtful comments. I completely agree that lifelong commitment to learning makes for the very best doctors around. Many young physicians can learn a great deal from your words.
      Best regards,

  5. As a cancer patient, my most trusted doctor is the one who is willing to say “I don’t know” because he always follows it up with research to find an answer. The doctors who appear to know everything are the ones that make me feel wary.

  6. Patients are often impatient.The burden of ailment distracts their right thinking abilities at times , when the degree of distress is beyond comprehension. At those moments no one likes the articulation of shortcomings of doctors. But when situation changes , it is a different time and frankness can be endorsed.In other situations when the vastness of knowledge is the issue where discussions are with logistics, there , I agree, the phrase would do wonders. For leadership to sustain and to persist, the sentence “I Don’t Know” does not seem to be interesting.This does not propagate positive emotion.

  7. Have never had a doctor say “I don’t know” to me, but have had several say “We don’t know”, and go on to explain what “the profession” is thinking about a medical issue upon which there is limited knowledge or consensus about cause, treatment, or prognosis. If there’s anything in that which diminishes a patient’s confidence in a physician, don’t know what it is.

  8. The greatest advantage of “I don’t know” is that it makes you more credible later on when you say “I know”.

  9. As a patient, I appreciate “I don’t know” from a doctor. As an engineer who has spent over 40 years understanding complex systems the human body is a particularly interesting challenge. And an unsolved one at that. So I don’t see “I don’t know” as a failing of the doctor, but rather a statement on where we are in the understanding of that complex system. Just be prepared to engage in a discussion explaining what you do know about what is going on, because I’m going to try to understand it to the best level possible without going to medical school or having an advanced biology degree.

    Now I may be unusual in my willingness and ability to dig into the technical details, but (unlike 100 years ago) most families have someone like me. So my Mother might not understand what you are telling her, but if she relates something to me that doesn’t make sense you’ll be hearing from me. Treating me like an intellectual peer, if not subject matter expert, is the right way to go.

  10. I just fired my doctor because he’s a pompous ass who isn’t interested in thinking about something from another perspective other than his own pharmaceutical-based training. Instead he thought it better to make fun of me in front of a medical student and his staff.

    In the end I am the one responsible for my health, therefore I become informed and educated on my health issues. I can read medical journals too. And bonus for me, I’m not stuck in a silo of doing things only one way for the majority of my life, thinking I have all the answers. I can look at things from a ton of different perspectives before I chose my cure.

    • Dear Jill
      Kudos to you for being and engaged patient. YOU have taken control of your own healthcare. It is imperative to partner with a MD that you trust and can work effectively with! Thanks for reading my blog

  11. Of all the many evidence-based medicine grading systems used to rate the quality and strength of evidence and to develop clinical practice guidellines, are there any that specify a category “We don’t know”?

  12. I am a doctor, and it surprises me that so many of my bretheren are unable and unwilling to say “I don’t know.” I am a vascular surgeon, and I often explain to people that although they think my primary job is to invade their bodies, in fact my primary job is the management of uncertainty, with emphasis on the uncertainty. Once they “get” that, they become much better patients since they understand what’s at stake.

    • Dr Nelken
      Thanks so much for your thoughtful comments. I think that engagement and active participation between doctor and patient is critical to success. realistic expectations are paramount!
      Thanks for reading and commenting on my blog

  13. As a member of a support group of a rare dx(under dx’d) this is a constant complaint. Too often we are met with “You have to understand …this is a rare disease..” at that point on to interview someone else…What I counter it with instead is as engineer when I don’t know something I have been taught how to find it or people who do know so I comeback to that with..”You know I don’t mind a doc who doesn’t know..I do mind one who is not willing to find out and learn…” I am in a city with five med schools and for 2 years I have been a human football, had docs walk away from me and just recently one of our members was laughed in the ER about the complications that occur as a result of this dx. and sent home, only to be called back as she had a life threatening infection…I sorry its a position of respect and responsibility…there are lots of other things you can do with a medical degree if patient care is not your cup of tea.
    If you are up to the job admit to yourself your lack of knowledge and go find it for you and your patient.

  14. I would much rather be told “I don’t know” than given some false hope that doesn’t come true. Honesty has to be a doctor’s policy, along with the other categories he/she needs to fill. Any doctor that pretends to know every single thing about every single thing? I don’t trust them.

  15. Colleen Cartier

    I appreciate your blog. I have had a mysterious illness for the last 5 months, leaving me extremely fatigued, Short of breath, nauseated, and with aching muscles and joints. Went to a total of 5 MD’s, one who said he didn’t know, one who is still searching for answers, one who went to a convenient trial diagnosis (asthma), and two that blatantly told me they thought it could be depression, despite my telling them I knew what depression felt like and that I was not depressed. I have been on antidepressants since 1995 or so and I have not been depressed since that time. The antidepressants help me feel “normal” and that’s why I keep taking them. (More even in my temperament). It is very insulting to be labeled with “mental problems” just because the doctors find it convenient when they don’t have the correct answer. Well, through researching I found out that the medication (metformin) I was started on in May was probably causing my symptoms. The shortness of breath can be caused by lactic acidosis which is very serious and can be life threatening. (A possible side effect of metformin) When I called my primary MD he refused to do the test for lactic acid because he didn’t think that was the problem. Frustrated by not having any cooperation or proof and thus a definitive cause of my problems, I went off the metformin anyway 5 days ago, and I have myself back again. I was honestly thinking that I had some terminal disease because I felt so terrible.
    So three things to note: If you are a MD, don’t just throw someone under the bus and label them with mental problems when they take antidepressants just because you don’t have the answers. And secondly, always be your own best advocate and keep searching for the correct answer. And thirdly, don’t overlook the obvious. I and my doctors should have first looked at my medications and ruled them out.

  16. Embracing our humanity (foibles and all) opens so many avenues to truly communicate real needs and hopes from all avenues. My clinical hope to find better answers absolutely rests with listening and learning. Granted, my area (PA-C/Psychiatry) thrives on communication, but imagine how much more effective we might be embracing this paradigm shift. Superb article! Planning on pointing others to it.

  17. Thank you for writing this article. It’s filled with more wisdom than I can convey. As a member of “the team” I appreciate your outlook, it’s very inspiring. In fact, I’d close my practice to come work on you’re team tomorrow if I could. I learned these words while working as a trauma counselor/crisis team counselor for a police department on the streets & in the various units: homicide, child abuse, sex crimes, family violence, vehicular homicide & robbery. While working a homicide, a car accident, a plane crash, I learned to say “I don’t know, but I’ll see if I can find out” & it made all the difference in the world to a frightened or grieving family member or friend who may be experiencing the worst moment in their life.

    • Ms Bramble
      THanks so much for taking the time to read my blog post. Your comments are much appreciated. If we can work as a team every single day, all of our patients will benefit beyond and words that you and I have to describe! Best of luck with your team!

  18. Dr. Campbell:

    Thanks for re-cycling this wisdom and potential gateway into humility for many. In 1984 Mark McCormack published: ‘What They Don’t Teach You at Harvard Business School: Notes From A Street-Smart Executive, New York: Bantam’ which summed up the kernel of wisdom potentially found in the more widespread use of the phrase ‘I don’t know’ – both in business and medicine I might add.

    Clearly Hanke is minimally channeling McCormack’s message albeit to those who may have a shorter event horizon than some of us in this conversation. None-the-less, this is a timeless reminder for all of us to materially embrace.

    Humility as well as fact based context has a hard time in today’s 24/7 faux ’emotive news’ cycle. This is especially rampant via many of the cable news personalities who proclaim their opinion as ‘truth’ with a capital ‘T’.

    I suspect we’d be a lot better off, if the ‘frequently wrong, but never confused’ types practice a little more of this suggestive reflective ‘I don’t know’ humility.

    Gregg Masters

  19. Pingback: Longer Looks: More TV Characters With Mental Illness | Health Care

  20. Pingback: Longer looks: Problems with 'regular insurance;' more TV characters with mental illness; women dying younger

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