Confidence in Our Special Knowledge

Just as a physician develops special skills and knowledge through years of apprenticeship, all of us can become disciples of the Savior and be recipients of special light and knowledge.

by Rand Colbert, MD

A few days before graduation, my medical school arranged for a first year internal medicine resident to come and speak to our graduating class about the transition between medical school and residency. Of all of the bits of advice he offered us, one thing he said stood out above all others. He told us to “never let your patients discover that you are the fraud that you know you are.” Of course, this was supposed to be funny, but behind the humor there was a tongue-in-cheek reality that became very real over the next year for me and for every student in my graduating class.

One minute I was a student with a short white coat and the next minute, I wore a longer white coat with “Rand Colbert MD” embroidered above the pocket. It felt strange to actually be a doctor, and I felt like an imposter wearing the longer coat. I spent my one year general internship at the largest private hospital in Wisconsin, with over 700 beds at the time. I can remember my first night on call. There were only two of us interns in the hospital that night, covering all of the patients on our service. Our supervising physician was a brand new second year resident from Pakistan, who had completed her internship two years earlier, spoke English with a thick accent, and was more scared than we were. We didn’t see her all night (she hid in her call room).

I remember the first “code blue” that was called over the loud speakers that night. My pager went off simultaneously since I was designated to cover all emergency situations whenever a patient went into cardiopulmonary arrest. As I ran toward the room where the patient was dying, I wished I could go and hide with my senior resident. The advice given to us just prior to graduation by that wise internal medicine resident rang in my ears louder than the alarm sounding in the halls of the hospital.

By the end of the first month, I thought I had it down. I thought that being a doctor was about projecting confidence. I was partly right. Confidence was important, but faith in real knowledge and skills that I would develop over the course of my career would be much more fulfilling than the kind of “mustered” confidence we learned about from that resident prior to graduation.

There is a big difference between a first year resident and a physician who has been out of residency for ten years. The greatest difference is, obviously, experience. It has been said that it takes ten thousand hours of doing something to become an expert, and medicine is no exception. In my specialty, dermatology, this is a particularly obvious truth. The first ten times I saw a not-so-common condition in my residency training, I might as well have been someone straight off the street trying to guess what was causing Mrs. Flannagan’s intractable itching. With guidance from my residency faculty, I was steered to the correct diagnosis and treatment over and over again. This apprenticeship-style calibration between my fledgling brain and the minds of the twenty or so dermatologists I worked with allowed me to advance in the art of medicine specific to my desired area of expertise.

What ends up developing after residency is a “fine-tuning” of the skills and knowledge gleaned during the years of training. For many physicians, a “sixth sense” begins to develop, where even the slightest clue will lead to the correct diagnosis. This almost superhuman ability is due to constant observation, repetition and correction until signs and symptoms literally jump out at the experienced physician where they would be invisible to the untrained eye. A friend of mine who is an ER doctor told me a story about how he recently deduced that a woman’s bowel obstruction was caused by uncontrolled urinary retention without so much as a hint from the woman that she had a bladder twice the normal size. Like Sherlock Holmes, he latched onto a subtle peripheral clue and correctly ordered a bladder scan, which confirmed his suspicions.

Unfortunately, this can be challenging to explain to patients who are suffering from conditions that are chronic, that require more than a few seconds to relieve (like draining a full bladder with a catheter), or that require extensive surgery. In these circumstances the patient often begins to wonder if the physician really knows what the heck he is talking about. Creating trust with the patient is critical to the art of medicine and goes hand-in-hand with knowledge and experience in medical science. Patients these days are becoming more informed about the inherent challenges facing the physician and are wary of his or her actual experience or expertise in their particular problem. What differentiates the seasoned practitioner from the newly-crowned medical graduate is that the newbie “feels like a fraud” and has to muster confidence, whereas the expert is confident in his art.

Outside the field of medicine, these principles also hold true. Whether the desired pursuit is playing the piano, shooting a basketball, blowing a glass vase or sculpting a statue—special knowledge, skills and senses can be honed to the point of amazing levels of proficiency.

So what about spiritual matters? Can we develop ourselves to the point that our spiritual eyes can see things that our mortal senses can not? Can we “graduate” from the secular, unbelieving, skeptical world and step into a sure confidence of our place in the grand plan of our Creator?

Atheists may scoff at this aspiration, but even they are imbued with a kernel of this divine knowledge, though they recognize it not.

“In most of life’s greatest transactions, where the stakes are highest, it is to the heart that we rightly turn, although not in utter isolation from the rational and the reasonable. But to whom to marry, when to discipline a child, when to let go of a dream, what sacrifices to make and promises to keep—these are the decisions best made when emotion is moderated but not obliterated by reason, by logic, by “scientific” thinking. And these decisions are certainly made, not in the absence of truth, but in those very truths which logic and science may be powerless to detect.” (from The Crucible of Doubt by Givens and Givens)

As we read the scriptures, ponder and pray, and as we strive to live a life consistent with the spiritual truths revealed to us through the prophets and through Jesus Christ, we are calibrating our spiritual senses with that of the great teacher. Just as a physician can discover special skills and knowledge through years of apprenticeship with experts in his field, all of us can become disciples of the Savior and be recipients of special light and knowledge unattainable in any other way. Like a newly graduated medical intern there may be times when we need to “muster” our confidence in the face of trials or doubts, but as we grow and learn spiritually, our faith will mature into a sure knowledge of eternal truths. We may still struggle to explain (or even defend) this knowledge to those who question our faith—but that does not diminish the truth of these things.

“For what man knoweth the things of a man, save the spirit of man which is in him? Even so the things of God knoweth no man, but the Spirit of God. But the natural man receiveth not the things of the Spirit of God: for they are foolishness unto him: neither can he know them, because they are spiritually discerned” (1 Corinthians 2:11,14).

Rand Colbert, MD is a member of The Church of Jesus Christ of Latter-day Saints and is a practicing dermatologist.

Do you know someone who needs to hear this message? Please share it with them.

About randcolbert

I am a dermatologist in Cedar City, Utah.
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One Response to Confidence in Our Special Knowledge

  1. I used to say that half of what you learn in residency is the art of bluffing. It’s probably less than half, though.

    Like

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