Feeling comfortable with this statement is a key skill in general practice. Not every doctor finds it easy to say, but the more one can state it, the more one can use it as a career planning or appraisal tool.

"I don't know" is a useful phrase. Whether patients like it or not is another issue - some prefer the doc to know everything and to be directed and others perhaps gain more trust with someone who admits when things are not entirely clear.

To use “I don’t know” (IDK) as a learning tool, start to note down the times you say you don’t know in a day, if any (itself an exercise in mindfulness); what it is about, and rank the level of comfort with this (e.g. 1 - 5, with 1 being very at ease and 5 being extremely concerned). It can sometimes uncover an area worthy of a CPD day or some extra reading.

For example: three times in one day saying “I don’t know” about the same therapeutic area, yet feeling very comfortable with not knowing, would be very different to three times in one day and not feeling at all comfortable.
The ‘not-at-all comfortable’ might not denote more need for learning than the comfortable one, but it may be worth raising at an appraisal. The ensuing discussion might well reveal some unknown thin areas of knowledge, or it might even reveal some hitherto unrecognised anxiety or confidence issue that has nothing really to do with one’s knowledge base, and more to do with concerns about getting things right. Some doctors under stress give less attention to detail but, others go more obsessive-compulsive. So monitoring the “IDK” quotient could even be a measure of stress in some doctors.

In terms of career planning itself, to say that you don’t know what you want to do for the rest of your career whilst you are a medical student or trainee is somehow frowned upon. Is it just the culture of medicine that presupposes that one should know what direction one's career should take? I don’t know! What I do know is that there is huge pressure as a trainee to be hoovering up vast quantities of information in order that one should “know” stuff, so the phrase “I don’t know” doesn’t always feel good, even though it is a perfectly valid response in some consultations. In an oral exam for example, it would seem that it is not a good omen to say “I don’t know”. So perhaps this also gets transposed into the specialty choice issue as well. This whole issue of not knowing in both clinical and career situations is summarised rather well in an American med school parody.

The reason I am prompted to raise the topic of “don’t know” is that I wrote a new questionnaire for my web site recently. The first person who filled it in made a comment that she really liked the fact that one question “would you like a telephone discussion about your career” had the options yes, no and “don’t know”.

Her comments reinforced my understanding of the importance of IDK. She said that it was reassuring to see a don’t know option on there because it probably wasn’t a no but it wasn’t yet a yes. She also said that she didn’t want to feel rushed or pushed and that this option made her feel safe and in control. I had not quite grasped the significance of putting this option in, but her considered observations made me think more carefully about being given the option and permission to “don’t know” and how important this actually is in career planning. Interesting and reassuring too that after 25 years doing this role my clients can still teach me. I am sure many GPs would echo that.

My conclusions are that the earliest stages of a career reevaluation can be quite distressing and confusing prior to getting to the point of seeking support and objective feedback from someone. As a result, to be presented with yes and no options feels too committed and may for some be forcing either a retreat or a leap too far. It demonstrates how important it is to go at the speed that an individual is happy with where career guidance is concerned.

I am very at ease with a doctor saying that they don’t know what choice to make career wise or what they want. I would go as far as to say that in any situation where career concerns are being harboured or even resisted, the first step in the resolution of this can be to state the very same. “I don’t know what I want in my career” can initially be a catch-all for things such as doubt, stress, guilt, denial, fear, lack of ideas, plenty of ideas, though none of which seem workable or acceptable to others. I could go on. However, feeling free to state it without being judged can be quite liberating and enable progress.
For this reason I am always delighted when I hear a doctor say I don’t know - whether in a career consultation or when I have the need to be a patient myself. Bring on the I don’t knows I say. ●

The Sessional GPThis article first appeared in The Sessional GP magazine June 2015.

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