The Power of Admitting 'I Don't Know' in Medicine
In a profession where knowledge is paramount, oncologist Dr. Ranjana Srivastava makes a compelling case for the therapeutic value of uncertainty. 'Like many doctors, I used to think I was alone in my feelings of inadequacy; it took me a long time to work out that this is a silent affliction,' she writes, revealing a widespread but rarely discussed reality in medical practice.
From Certainty to Vulnerability
Dr. Srivastava describes her early career as a qualified oncologist, where she mastered technical skills like prescribing chemotherapy and interpreting results, yet struggled with patients' deeper questions. Medical journals provided survival curves, but patients wanted personalized answers about their futures. A recently separated father needed to know where he stood on that curve to plan time with his children. A matriarch wondered if a 12-month median survival meant she would definitely see her grandchild born in six months.
'The glum and silent answer in my head to such questions was, "I don't know,"' she admits. This internal conflict between projecting confidence and acknowledging uncertainty became a central theme in her practice.
The Evolution of Medical Knowledge
Medicine has transformed dramatically during Dr. Srivastava's career. HIV wards have closed in wealthy nations due to effective treatments. Stroke patients now have clots retrieved to restore full function. Kidney donations allow siblings to continue nearly normal lives. In oncology specifically, palliative care has matured, and patient autonomy has gained prominence.
Yet despite these advances, the human body remains humblingly unpredictable. Patients with aggressive diseases defy predictions, while those with excellent prognoses sometimes experience unexpected recurrences. 'Twenty-five years in, I find myself saying "I don't know" more, not less,' Dr. Srivastava observes.
Building Trust Through Honesty
Contrary to expectations, patients respond positively to medical vulnerability. Far from losing faith, they appreciate doctors who admit uncertainty while committing to the journey. '"I don't know" is not defeatist if it is followed by, "But I am going to stay the course with you and be open and honest about what I do know and can find out,"' she explains.
This approach challenges traditional medical training, where students learn to acknowledge limitations but newly qualified doctors feel pressured to have all answers. Dr. Srivastava advocates scrapping this 'mirage' of infallibility, arguing that self-awareness and honest conversation have no substitutes.
A Cultural Shift in Medicine
The oncologist highlights how multidisciplinary collaboration and technology help fill knowledge gaps, but emphasizes that doctors must often bridge uncertainties themselves through genuine dialogue. Reading a young radiation oncologist's essay about embracing 'I don't know' gave her hope that this realization is spreading earlier in careers.
'If medicine taught this more explicitly from the outset, our patients would be better served,' she concludes, calling for systemic change in medical education and culture. Dr. Srivastava's insights, drawn from decades of oncology practice, offer a powerful reminder that medical excellence includes the courage to admit what we don't know.
