Teach thy tongue to say I do not know.

Those of you who read my last blog through to the end will have seen a painting of the 12th Century Jewish philosopher, astronomer and physician, Maimonides – sometimes known as Rambam*. The painting contains one of Maimonides’ quotes –

‘Teach thy tongue to say I do not know and thou shalt progress’

I love this as it so very well sums-up who I am and my approach to life – it encapsulates the ideas behind Quality Improvement that I am so committed to pursuing.

Only by admitting your ignorance can you learn; contextualised within this is the idea that you must first feel safe to admit your lack of knowledge or understanding, to express this to others.

We move from ignorance to knowledge; pretence does not facilitate growth.

Safety is of great importance – people must feel secure, appreciated and valued – this perhaps why, in keeping with some of my recent experiences, my world sometimes feels stifling.

A culture of openness and honesty – one which allows people to challenge accepted wisdom, to question beliefs and norms, is the one which will survive.

This is another form of expressing, that good will triumph over evil, for, evil, whether in the form of bullying, oppression, state-sanctioned coercion or right-wing censure, this approach always stifles creativity; the innovation required to win the war, to topple the dictator, comes from freedom of thought.

I was talking with colleagues last week and expressing the difficulty some doctors have when they don’t know what is wrong with a patient. There is a pressure to think of something, anything, to provide a diagnosis, and with this, an action, test or treatment which is potentially wrong.

Candour – ‘I am sorry, I don’t know why you are in pain/confused/tired/breathless’ is perceived by those who are less experienced as a demonstration of ignorance, rather than of openness or confidence;

Yet, ‘I do not know,’ allows the doctor to engage in a more open discussion with their patient and others, to determine the cause. (We move from the folly of one to the wisdom of the collective), This allows one to learn.

I am fortunate – I have been around long enough to be confident in announcing my ignorance;

This should perhaps become integrated into the training of doctors and nurses, physios and pharmacists – the conviction of ‘I don’t know’ aligned with, ‘I will find-out’ as a basis to the clinical interaction with a patient.

To revert to the personal – Dad, did you get the job? Why did I not get the job?

I still don’t know.

I haven’t been provided with an adequate explanation.

And this, is another form of ignorance when we are left in doubt, when we are left looking for answers and all we have is hypothesis and soul-searching; perhaps I was too slow, too limited, not right, perhaps, the stars were not aligned or, the politics out of synch.

Whatever;

In these situations, it is our natural instinct to look for answers; and finding none, we go on until we have forgotten what it was we wanted. This is growth.

Ignorance is not bliss.

Don’t just leave your patient with, ‘I don’t know,’ provide them a framework, a timescale for your investigation; safety-net, action-plan.

No one enjoys limbo.

rambam.jpg

*For those of you who are super-observant, this is the guy on the back of my phone.

 

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