No such thing as certainty: Lessons from a career in general practice

Before I started wielding a stethoscope and a pen for real, I was forewarned by some experienced and extraordinary teachers.

Now that I am of a certain age, I have been asked what advice I would give to recent graduates.
 
Here it is.
 
When we accept registration as a medical practitioner we accept a lot of responsibility, which is hopefully balanced by community respect and adequate remuneration.
 
This career is not easy. If it were then anyone could do it.
 
Contrary to popular belief, the internet is no substitute for a good doctor. Access to information does not instantly mean that we can appropriately apply it.
 
There is no certainty, except for uncertainty. There is no constancy except ongoing change.
 
Information has a use-by date, due to developments in research on health and illness, improvements in therapeutics, and the fact that over time our understanding of many diseases changes and our information becomes outdated.
 
What was relevant three years ago may be irrelevant today.
 
It is better to be an agent of progress than a victim of change – keep learning and add to the knowledge of the profession.
 
Crap happens – in spite of our best efforts, bad outcomes sometimes occur.
 
Mistakes are not necessarily a bad thing. As I learned in high school woodwork class – a person who never made a mistake, never made anything. Our knowledge is imperfect. Human beings are incredibly complex. We learn more from mistakes than successes.
 
Experience is what is left when we survive our mistakes. We just have to ensure that a mistake does not occur because we have been careless, because of something we already knew or because we were impaired due to tiredness, illness or intoxication.
 
Magic happens too – even when things look bad, good outcomes sometimes occur.
 
Common things occur often, but statistics are no protection against the rare. Always distrust the obvious, at least until it has been confirmed.
 
The patient is the person with the problem. We did not cause the illness, accident or incident, we are responding to it. All that can be asked of us is to do a good job.
 
We are paid for our time and efforts, not for our results. So when you face an incident do the best you can at the time.
 
Only judge yourself on what you knew and could find out at the time. If you discover other information later, it is irrelevant to your actions during the incident. What is beyond your control is beyond your concern.
 
‘If’ is the shortest word and the longest sentence – it is far too easy to persecute yourself with the possibilities of actions other than those you took.
 
I remember as a child I was once wallowing in the distress after I made an unfortunate choice.
 
My father, whom I still miss every day, said ‘So are you saying that if things were different, they’d be different?’
 
I still find that enormously comforting.

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