Doctors are supposed to know everything, right?

18 06 2010

A friend of mine passed along an article from the New Yorker by Atul Gawande entitled ‘The Velluvial Matrix’.

As doctors, we all know what the Velluvial Matrix is, right?  I had to double-check, myself, but it turns out that it doesn’t exist.  The article is an enjoyable read for any physician; it’s one of those oh-my-gosh-that-totally-happens-to-me-all-the-time articles.


Since I graduated from medical school, my family and friends have had their share of medical issues, just as you and your family will. And, inevitably, they turn to the medical graduate in the house for advice and explanation.

I remember one time when a friend came with a question. “You’re a doctor now,” he said. “So tell me: where exactly is the solar plexus?”

I was stumped. The information was not anywhere in the textbooks.

“I don’t know,” I finally confessed.

“What kind of doctor are you?” he said.

I didn’t feel much better equipped when my wife had two miscarriages, or when our first child was born with part of his aorta missing, or when my daughter had a fall and dislocated her elbow, and I failed to recognize it, or when my wife tore a ligament in her wrist that I’d never heard of—her velluvial matrix, I think it was.

This is a deeper, more fundamental problem than we acknowledge. The truth is that the volume and complexity of the knowledge that we need to master has grown exponentially beyond our capacity as individuals. Worse, the fear is that the knowledge has grown beyond our capacity as a society. When we talk about the uncontrollable explosion in the costs of health care in America, for instance—about the reality that we in medicine are gradually bankrupting the country—we’re not talking about a problem rooted in economics. We’re talking about a problem rooted in scientific complexity.

These sometimes awkward situations are especially common, I feel, for Pathologists, as we do not even have the day-to-day contact with patients that primary care docs do.  Heck, I have no idea where my ophthalmoscope is, and I currently use my stethoscope as a make-shift stud-finder!  Yet, as doctors, our friends and family definitely expect us to be the final answer on anything from rashes to cancer.  Of course, I’m not saying that I don’t remember *ANY* of my training- I can still answer some basic questions, or I at least know where I can go to get an answer, and I can still do a physical exam if I had to, but I feel that it’s pretty safe to say that other people greatly overestimate our memory banks.  [Note: For some reason, I feel like a magician that just showed the audience how he did his trick.]

When I first graduated medical school, empowered, I tried to be that endless fund of medical knowledge for anyone who had questions.  Now, as a fourth year resident, if there is a question I am not prepared to answer, I will tell people that they should see their doctor!  I guess that some people will think that that is a cop-out answer, but I think it is more a demonstration of learned temperance, such that by saying “I don’t know”, you are actually being more wise.

The article goes on to talk about health care reform, etc., etc. but the first half is quite enjoyable and thought-provoking.


NEW! 1xObjective Flickr Account

7 06 2010

In an effort to be as meta as possible, The 1xObjective, has expanded to include a Flickr account at

Ideally I’ll be able to share static images of cases there for now until the NanoZoomer goes operational.

First Case is already posted!  It’s a super interesting autopsy I did.

Peribronchial RML Mass, 4x, H&E

See how many diagnoses you can pick out…

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