Rushing into the Nephrology morning conference, I tried to avoid as much eye contact as possible. “Damn it! ATN! That is always the answer”, I thought when a nephro fellow answered a question posed by one of the professors. There goes my chance of answering at least one question right this morning.
"A unit of blood increases the recipient’s hemoglobin by 1 g/dL." I've heard that in passing before. So that is my salvage from the embarrassment of arriving late today. I answered and immediately forgave myself for the morning. It is funny how, as residents, we feel guilty for things we have no control over. Arriving late at the nephrology morning conference was the direct consequence of the medicine morning conference that did not end at 9:00 like it was supposed to. But that is a story for some other day.
Two years later, as I commute to work, I listen to a medical podcast discussing this exact issue. Why do we assume that a unit of blood increases one's hemoglobin by 1 g/dL? They present studies and observational data and thoroughly dissect this super-common belief in medicine. I wondered how many of these clinical pearls I have accepted and memorized during my medical school and residency. As the podcast ends, I write a note to myself: Be intellectually honest.
I have not been able to define intellectual honesty for myself. Is it quoting the study that familiarized me with the concept? Is it mentioning the podcast that I learned it in? How do I remain intellectually honest to myself and others? This is my documentation of the progress I've made so far.
Oh, oral lasix won't work during heart failure exacerbation because....? If you have any internal medicine experience, you would have heard the answer to that question: the famous gut edema and the problems it brings to absorption. The Curious Clinicians is a medical podcast where they try to see the legitimacy of this concept. They present another theory of delayed gastric emptying and try to support it with much evidence. Now, there is no way I will have 20 minutes to do the same with my residents during morning rounds. After all, we have 18 patients to attend to, social workers and utilization managers to talk to, 36 notes to write, and other unexpected but inevitable fires to put off during the day.
But I also don't want to teach using random clinical pearls only for one of my residents to graduate, live far from his/her work, commute for 2 hours, and realize while listening to the podcast that the phrase "adequate post-transfusion correction" has so much work and so many people behind it. And that adequate post-transfusion correction of 1 g/dL is an oversimplification.
Intellectual honesty isn't just about referencing the source or mentioning a range instead of a discrete number. It is rather an invitation to explore. It is the act of not dismissing the curious minds of medical students and questioning even the basic facts with them. It is dropping the act of an all-knowing entity and joining the gang of inquisitive learners. It is being content with the fact that there will always be something more to know, some better explanation. Intellectual honesty says, "This has been my understanding, but I don't think I have ever questioned it. Thank you for helping me question it. Let's explore that further."