I spend quite a lot of time fairly unsure that I really know enough about the stuff I should know about. Sometimes I think we could benefit from reflecting on this a bit:

Are there known uncertainties – things which we have a good estimate, based on good research, but gives us an answer which isn’t clearly one way or another (like early discharge for low-risk febrile neutropenia)?

Are there clear ignorances – things where we know that we don’t know about that stuff (for me … acute ataxia that isn’t a cerebellar tumour or recent removal from a merry-go-round)

Are their nibbling unconvincings – things where you know what you have always done, and probably will do again, but aren’t sure it’s really right (e.g. using 0.45% saline for IV maintenance fluid)?

Are there blasts of amazing newness – where someone slaps you with something you have had no idea was a thing or what to do about the thing (I heard about something called “Mauriac syndrome” the other month ?!??)?

These types of unsureness can be resolved with very different approaches. The first line – the known uncertainty – can only really get better if there are more studies, or if the decision is shared one-to-one with the patient and family to whom it applies. The clear ignorance is relatively straighforward to fill: find a good background article that can supply the necessary gap-filling. For this, I’d heartily recommend the “15 minute consultation” section of the (green) Education and Practice section of the ADC. Nibbling unconvincingness is (obviously!) best addressed by you looking at the evidence, and summarising it if necessary … via an Archimedes perhaps?

The final lot – the unknown unknowns – are most dangerous and most unfillable. You just need to keep you ears and eyes open, and constantly taste the air for areas in which you are shockingly ignorant. An open mind – let call it #ThingsIdidntKnow – is the best way out of this. We need to support each other in letting this happen and celebrate the gaps in our knowing.

– Archi