A monthly column featuring insights and ideas on the most challenging communication issues facing health care professionals

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Admitting You Don't Know It All

"I don't know."

In a perfect world, we would never need to utter those three words in health care. Every diagnosis would be absolute. Every critical piece of information would be known. Every decision would be obvious and definitive.

But of course, we don't live in a perfect world. Uncertainty is an everyday reality in health care organizations for countless reasons. Despite near miraculous advances in diagnostic technology, treatment methods and electronic data access, disease processes do not follow a fully predicable course. And even when knowledge and data are available, many of the issues we deal with are so complex that it would not be humanly possible to be all knowing at all times.

But uncertainty does not exist exclusively around clinical issues. The pace of work and sheer volume of information in most jobs in health care make it difficult to always be familiar with every aspect of every issue.

The reasons why uncertainty exists are clear. So why is it often so difficult for us to admit, "I don't know" when asked a question by a colleague, patient, family or physician? While individual circumstances certainly affect our ability and willingness to candidly admit we don't know, culture and traditions in health care actually make it especially difficult to confess that we don't have an immediate answer to a question.

The all-knowing culture likely has its root in the training of health care professionals, particularly physicians. Medical schools teach physicians in training to be exceptionally well prepared, confident and decisive. Why shouldn't physicians have every answer; after all, only the best and the brightest in our society make it into medical school and become physicians.

So if physicians must have all of the answers, shouldn't the people they work with match up to the same standard? Clearly, nurses and other clinical professionals feel some degree of pressure to have the right answers at the right time when working with colleagues in health care, especially physicians.

Intelligence, knowledge and confidence are all essential characteristics for health care professionals. But when the pressure to be intelligent, knowledgeable and confident exceeds our human ability to actually deliver on these high expectations, the consequences can be disastrous. Trying to piece together an answer to a critical question when we don't have the absolute answer - in other words, making an educated guess - can only increase problems and potential errors downstream.

When the right answer to a question is some form of "I don't know," here are several tips to help make that admission easier and more palatable to colleagues, patients or families.

Often there are defendable reasons why information is not available. Perhaps the conditions of a patient case or other situation are changing and you need more up-to-date information. Or the other person's question concerns an issue or area that you have legitimately not focused on up to this point. If so, briefly explain those circumstances in a non-defensive way. Then quickly get on to the second recommendation …

Most people will be more understanding if they see your commitment to helping them get the answer they need. But be careful. Don't commit to uncovering an answer or solution that you're not sure exists or for which you must depend on others to produce. Following up with an answer promptly can often win you more points than you expect. For instance, if you are in a meeting and offer to find the answer to a question that you don't immediately know, consider sending a quick email message after the meeting. Others likely will be more impressed with your responsiveness and commitment to satisfying their needs than if you had the answer at your fingertips in the meeting.

You may not always have the complete answer to a question, but hopefully you have some understanding of the issues surrounding it. Briefly and respectfully explaining these areas can be helpful to others, especially in patient care situations. If you don't have a definitive diagnosis and treatment plan for a patient, for instance, offer what understanding and knowledge you do have about her case. If you are dealing with a hospital or clinic operations issue, try to focus on those elements of a situation that are of greatest concern to the other person until you can get a definite answer.

Taking responsibility is appropriate and admirable. Taking more than your fair share of responsibility is unnecessary. Most situations in health care involve a team of people working together. Instead of "I don't know whether you'll be able to go home this afternoon, Ms. Williams," try "We don't have the final results back on your radiology test. When we do, we'll be better able to tell you if you can go home."

Letting the other person know that you're sorry that you don't have an answer for them is considerate and doesn't necessarily have to mean you are taking blame for the lack of information. Expressing regret simply acknowledges their inconvenience or inability to use the data they've requested to solve a problem.

Finally, at times there are situations where the fact that you don't have an answer is your fault. Maybe you've been too busy to follow-up on a question or you haven't been able to stay on top of an issue as well as usual. Remember that is it far better to take responsibility, suffer the results and try to correct the lack of information instead of guessing or making up an answer. If you are wrong and it causes more problems down the road, the wrath of the person counting on you - plus the potential bad consequences from wrong information - will cause you far more problems. In addition, you'll erode your level of trust and rapport with the other person.

While we all strive to be as up-to-date and knowledgeable on issues as possible, no one can always be all-knowing. It is much better to communicate uncertainty tactfully and promptly than to risk harming relationships - and potentially patients - by guessing.