The trouble with juniors

Now that I've graduated from idiot to king of the idiots, I've come to realize that juniors come in a variety of flavors. There are those scared to commit to anything, like I was, and there are those that don't know what to do, and there are those who know what to do. It's kind of like what Rumsfeld once said: ... there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns - the ones we don't know we don't know."

This was an oft criticized quote, but I thought it showed remarkable insight, and this one quote should preface every epistemology text. Anyway, the same is true with juniors, and all of us really. There are things that we know we know. And things we know we don't know. And by and large, we're comfortable with these things. The dangerous place becomes the realm of things that we don't know that we don't know.

That is what my experience of junior residents is. It is the continual exercise of, "Wait, hyponatremia has to be corrected slowly" or "You don't need levaquin and ceftriaxone for pneumonia" or "the patient needs to go to the cath lab right now." It is watching people display their blissful lack of knowledge.

This is my job. I've come to accept it. The frustrating thing becomes watching people defending their stupidity. "Well, the ER started these two medications" or "But she's getting better with what we're doing."

The most frustrating thing in life is trying to reason with someone who will not concede a position of ignorance.

No comments: