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Finding and creating knowledge

Where there isn't enough knowledge to guide us, we can find and create our own knowledge in practice.
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Hello and welcome to week 2, tackling not enough knowledge. During week 1, we reflected on the challenges and uncertainty we all encounter in practice and how developing our knowledge work skills could help us to navigate the complex situations we face everyday. Recognising that our clinical expertise is based not only on what we know, but how we use what we know to help our patients. What we know of course influences our decision-making. Sometimes we know too much, making it difficult to integrate multiple, perhaps conflicting pieces of knowledge about a patient into a whole-person centered understanding of their illness. We’ll explore the problem of too much knowledge further in week 3.
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First, we’ll explore the reverse situation, when we feel we don’t know enough. It’s likely that we’ve all encountered situations where the guidelines or existing research don’t give us all the answers we need. Patients commonly present with persistent symptoms that don’t have a clear explanation, for example; fatigue, dizziness, swallowing problems or non-specific pain. Investigations often provide us with no answers. This can lead to complex consultations without any simple outcome. Some patients may seek out a hero doctor, such as the diagnosticians idolised on television shows. Someone, who can find their illusive diagnosis and fix their problems.
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However, if left unchallenged, this view of how good medical care should always be delivered can potentially lead patients down a path of over-investigation, increased health anxiety and harm. The real hero in this scenario can be the doctor who steps up to the challenge of shifting the patient’s goal from solving to explaining their symptoms. In these situations, where there isn’t knowledge to give us a single, clear answer, our professional role is to find and create an explanation, through rigorously generating new knowledge in practice. This week, we’ll share with you some tools to enable you to work with patients to explore their experiences and expectations and help them to find a better path to recovery through a shared explanation of their symptoms.

Welcome to week 2, tackling not enough knowledge!

In this video, Dr Annabelle Machin introduces the aims of week 2 of the WISDOM course, considering how we can find and create knowledge in practice, to help us when the guidelines or existing research don’t give us all the answers we need.

Video reference

Wenzel RP. Medical education in an era of alternative facts. N Engl J Med. 2017;377(7): 607-609. DOI: 10.1056/NEJMp1706528

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