Book Recommendation: “What Doctors Cannot Tell You”

Quite often I get asked, what is the biggest challenge that doctors face? There are many challenges, but I think the most important one is to realize that doctors do not know everything, and be able to communicate that to the patients. It’s not rare to hear from patients saying “why don’t you tell me what to do. You are the doctor.” The reality is that sometimes doctors simply do not know what the right answer is. For example, often there haven’t been good studies to compare the efficacy of conventional and alternative treatments, and it is up to the patient to make an informed decision for what he/she would like to receive, or denies all options offered.

For colleagues in the medical field who wish to better communicate with patients while being aware of these challenges, I would like to recommend a book written by one of my mentors, Dr. Kevin Jones. The book is called “What Doctors Cannot Tell You. Clarity, confidence, and uncertainty in medicine”.

Dr. Jones studied English Literature at Harvard and Medicine at Johns Hopkins before specializing in Orthopedic Surgery at the University of Iowa. I had the privilege to work with him on research projects when he was a fellow in Toronto. He also facilitated my first operating room shadowing experience as an undergraduate student, which was a 12+ hour sarcoma case, during which I watched for almost 10 hours without stepping out the room for refreshment or bathroom break. That’s when I knew I had the stamina to pursue a surgical specialty. Funny enough, I left the room when the plastic surgery team stepped in for reconstruction, which is the specialty that I ended up in. He has provided invaluable advice over the years throughout undergraduate studies, medical school, and now in residency. Dr. Jones is currently an orthopedic oncologic surgeon-scientist and Associate Professor at the University of Utah, where I last visited him in 2010.

For premeds who wish to better appreciate this challenge, I would also like to recommend this book to you. In fact, the book has a succinct summary on some of the toughest questions patients may ask, and what the principles are to address them. This is a great resource to help you answer questions during medical school or residency interviews. I will share with you three examples from the book:

1. Diagnosis

Patient asks: Have we ruled out everything immediately dangerous? What else is on your list of possible diagnoses for my condition? What is next?

Principle: Physicians organize potential diagnoses for each patient according to how common, how dangerous, and how easily ruled out each is, then proceed down an algorithm hoping to arrive at a final diagnosis with the patient.

2. Treatment

Patient asks: Will we slowly ramp up our treatment until symptoms resolve or hit it hard then try to scale back later? Will we be able to scale back later?

Principle: We will either over-treat or under-treat every ailment. For very dangerous conditions we are very wary to reduce the severity of our over-treatments, for fear of failing to win as often.

3. Difficult decisions

Patient asks: What should we discuss now that we might not be able to discuss if my condition worsens more rapidly than expected?

Principle: There is no time like the present to discuss what will happen if a patient loses the capacity to make decisions for him/herself.

Finally, I would like to recommend this book to everyone who believes in building a healthy and trustworthy physician-patient relationship. The book is available for purchase on Amazon.