Launchpad: You Are Not Supposed to Have All the Answers (Part 1)

Part I: Learn to Be Decisive Anyway

I remember one of my first days in general practice like it was yesterday. I was finally on the floor. I was seeing appointments and managing walk-ins alongside my fellow practitioners with my own technician/assistant team. That morning, a canine neuter was scheduled, and a walk-in with an abscess needed lancing. The technician asked expectantly, “Which procedure do you want to do first? What do you want us to use for preoperative meds? What about postoperative meds and meds to be sent home?” 

I had 2 crucial realizations in that moment: (1) This was real! I was the doctor. The buck stopped with me, and people were looking to me to be decisive. (2) My immediate gut answer to all those questions was, “I don’t know, I don’t know, I don’t know!” 

• What did the order of procedures matter?! 

• I had studied various medications and memorized their adverse effects, but should I err on the low or high end of the administration range for neutering a healthy patient? 

• Without culture results, what was the best empiric (yet responsible) antibiotic to treat an abscess, and how long should I treat it?

I had plenty of knowledge but no clinical experience. I had not been a practicing vet until, well, that day. Even though I expected to know everything right away, I now realize no one else had those expectations of me. The technician was not quizzing my clinical competency; she was merely trying to make a plan. 

This day stands out to me because it taught a difficult lesson: Sometimes, you have to be decisive without knowing all the answers.

With time, I learned that I preferred to warm up on surgery days by starting with procedures I considered easy (eg, feline neuters) before doing more complicated procedures (eg, Great Dane spay). In contrast, a colleague preferred to do complex surgeries first because she found them stressful and preferred to get them out of the way. There is no right way, and you will find your groove. 

Similar to the 5×5 rule (ie, if something will not matter in 5 years, do not spend >5 minutes fretting about it), this veterinary modification can help: Don’t spend time agonizing over answers you don’t know if they don’t really affect the care of your patients; be decisive, and adjust over time as you gain clinical experience.

For those things that do affect patient care, it is okay to admit you do not know something. You are not supposed to know all the answers. You do, however, have background knowledge, resources, and mentors you can consult. On the day I described above, I deferred to the standard protocols of a mentor. I decisively gave medication doses within the safe ranges and durations I had learned or found in my drug handbooks. I thus did no harm and, over time, modified my protocols as I gained knowledge and experience. There is a reason why they call it the practice of medicine, after all.