VICDOC Summer 2023 - Magazine - Page 85
As a new intern, it was very straight forward
to differentiate ‘known unknowns’ and
‘unknown unknowns.’ I knew I had little
experience, and so everything was a
‘known unknown.’
—
"
are known knowns; there are
T here
things we know we know. We also
As a new intern, it was very
straightforward to differentiate ‘known
know there are known unknowns;
unknowns’ and ‘unknown unknowns.’
that is to say, we know there are some
I knew I had little experience, and so
things we do not know. But there are
everything was a ‘known unknown.’
also unknown unknowns – the ones
The very first time I set pen to a
we do not know we do not know."
medication chart on my own initiative
That is how former United States
(bowels opening, refusing regular aperients,
Secretary of Defence Donald Rumsfeld
change to PRN) – you bet I ran that by my
infamously put it in a 2002 news briefing,
registrar afterwards! Now, of course, I make
but the formalisation of ‘known unknowns’ countless such small decisions every day
and ‘unknown unknowns’ can in fact be
while rounding, admitting, discharging,
traced back more than 100 years, to the
and reviewing
general practitioner and cardiologist
As my experience and scope of
James Mackenzie in 1919.
practice expand, however, and as I am
When I started my internship, the
required to apply increased knowledge,
goal of my year was to learn those things
the task of distinguishing the ‘unknown
I knew I did not know. Yes, as I wrote
unknowns’ grows more difficult, and the
in my first article of this series, medical
consequence of misjudgement is to err.
school taught me the different classes of
The consequences of an error as a student
antihypertensives, but it did not teach me
were limited to embarrassing yourself or
how to dose them or when to start them
losing marks on an assessment; as a doctor,
in my hospital inpatients. That I have now the potential consequences weigh more
learned. As a graduating medical student,
heavily. On one occasion, while completing
I also worried about my lack of experience
an admission, I prescribed a medication
managing seriously unwell, deteriorating
for a patient in whom I failed to identify it
patients as a first responder – this, too, I
was absolutely contraindicated. Thankfully,
am slowly learning about. But I have also
the error was quickly identified by
come to appreciate the equal if not greater
another doctor and remedied; had it been
importance of learning that which I did not administered the consequences may have
know I did not know.
been catastrophic.
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