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Trial and Error: Honesty is the best policy

Honesty is the best policy

It was my final internship at the department of Cardiology, the final test before becoming a real doctor. My supervisor had asked me to attend to a patient at the Oncology ward. The patient was diagnosed with stage IV lung carcinoma and the oncologist was worried about malignant pericarditis. I did a physical exam and went back to my supervisor. Evaluating my findings, my supervisor asked me: ‘was this patient’s central venous pressure (CVP) increased?’. I had not checked the CVP carefully, but I did not remember seeing a bulging jugular vein. Thus, I answered ‘his CVP was not increased’. My supervisor answered that in this case, an echocardiogram to check for pericardial effusion or tamponade was not indicated. After that, it dawned on me that the CVP was a key information in this case. I felt embarrassed that I had not answered my supervisor truthfully, as I was really unsure whether the CVP was increased or not. I immediately went back to the patient and found out he did have an increased CVP. I headed back to my supervisor, explaining him what just happened. He laughed and told me I made the right choice of visiting the patient for the second time.

Most interns will recognize the story above in a similar way. Do not be afraid of making a fool of yourself or not fulfilling the expectations you think your supervisor has. As an intern, still developing your medical skillset, you are not to worry if you are not complete in your medical history or physical examination. But be honest about it, because certain doctors will trust your findings without checking them, which could have major consequences. Besides, showing your uncertainty is one of the competences of a complete doctor.

G. de Waard

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