WWUViking1983 Posted August 10, 2015 Share Posted August 10, 2015 Maybe not the right place for this post, and if so, forgive me... So I was browsing the PA/NP forums over at SDN, and a phrase I saw tossed out repeatedly was "midlevel providers don't know what they don't know." As a brand new PA-S, I'm curious... WHAT exactly does that mean? Is it a way of approaching patient care that doctors learn and PAs don't? A paradigm for developing a differential diagnosis? Is it in reference to more advanced biochemistry in med school? Sure, PA school doesn't cover the breadth or depth of med school. A freshly minted PA-C doesn't know what a first year resident MD does. But then again, the resident doesn't know everything his attending does... Longer periods of formal education means a lot, but so does experience. I'd be willing to bet a PA with 5+ years experience can give a brand new MD a run for their money. I know more about EMS now then I did when I was a rookie EMT. As one of my instructors was fond of saying: "You learn medicine by doing. The classroom stuff is just nice to know." But then again, maybe I don't know what I don't know. :) Thoughts, my more learned colleagues? Link to comment Share on other sites More sharing options...
SHU-CH Posted August 10, 2015 Share Posted August 10, 2015 "Not knowing what you don't know" is a cute saying that insecure or arrogant people use to belittle others so they can feel more confident about their life choices. It suggests that "midlevels" will do things like misdiagnose retropharyngeal abscesses as a strep throat thereby causing people's heads to rot off. As you suggest, experience is king in medicine. The best way to get good is by laying hands on as many people as possible. You accurately note a new PA may not know what a first-year resident knows. Organized medicine can't handle the fact that a 10 year PA will know things a first year attending does not know. And both will know different things that the other does not know based upon their past experience. Maybe the PA was a paramedic; maybe the doc was. Medicine trumpets the vast number of hours that physicians go through in their training and claim this level of experience is essentially the only valid route to making a competent clinician. This argument is slowly falling apart. For example, if these training hours are so critically important, why did they not lengthen the duration of residency programs when resident work hours were cut? It used to be resident work hours were almost unlimited. I am not saying it was humane or a good idea, but residents saw a gazillion patients and learned how to work and make decisions under adverse conditions when they were exhausted. Now residents have strict times they can work - if they try to go over they get sent home. Why did they not lengthen their training to ensure equivalent experience? While experience is great, we also have to consider that there is some basic level of competence that makes someone a safe. effective clinician. There is an egomanical family practice doc that runs a blog where he questions why anyone would want to see a PA/NP when they can see a better trained family practice doc. If I had the time and the interest, I would turn it around on him - why should anyone see a family practice doc when they can see a better trained specialist? You have hypertension? Go to a cardiologist. Link to comment Share on other sites More sharing options...
FamilyPAC Posted August 10, 2015 Share Posted August 10, 2015 I don't think this 'quote' applies just to midlevels, but also interns, residents, etc. No one knows everything. I interpret it as meaning how can you diagnose a constellation of symptoms as x disease if you didn't know that disease existed (just one example). When I was in PA school, we had a professor that would say you need to learn to be consciously incompetent. It's fairly easy to recognize when you are in way over your head, but for those more subtle times I always wondered how you could be conscious of something you weren't aware you were incompetent in, similar to the saying 'you don't know what you don't know.' Link to comment Share on other sites More sharing options...
SERENITY NOW Posted August 10, 2015 Share Posted August 10, 2015 Yes, you will hear physicians say "you don't know what you don't know" at times, but it can mean a few different things. Sometimes it is said with genuine good intent, referring to anyone new in medicine, be it a PA, NP or resident. In these cases its just a means to encourage continued studying for life, with the understanding that nobody knows it all and we all have to continually learn. To answer your question, I don't think it is aimed specifically at one topic like biochem or a patient approach that is locked away only for physician education and not PA education. Many doctors will admit that nothing they learn is particularly complex or a secret, its just the massive amount of information that they have to learn. Other times, that phrase is aimed specifically at PAs/NPs, regardless of the level of experience and continued education they have, and is used as means to undercut our clinical abiliites. By saying this phrase, they are basically saying that as a PA we shouldn't even be able to speak about topics like "are PAs/NPs safe for patient care?", because 'we wouldn't even know it if we weren't.' At first I didn't know how to respond to this more malicious use of the phrase. But after some thought, I realized this same idea can be flipped back onto them... they don't know what they don't know. They don't know the rigors of PA school. They don't know (or atleast refuse to acknowledge) that experience + a passion for learning over time can have a huge impact. While the phrase itself "you don't know what you don't know" is true and does apply to medicine, its definitely not fair to use that as a sweeping generalization to undercut all PAs/NPs. I believe that PA school represented "a foot in the door" into the world of medicine, and the 2 years is just a blip in the radar of a journey of lifelong learning. Link to comment Share on other sites More sharing options...
UGoLong Posted August 10, 2015 Share Posted August 10, 2015 This quote applies to everyone in every profession. Life is a sport that's learned by doing. Have a healthy dose of humility is a good idea, regardless of what initials follow your name. Link to comment Share on other sites More sharing options...
fishbum Posted August 10, 2015 Share Posted August 10, 2015 I've heard that more than once, and it's got to be one of the most useless "mantras" out there. The statement implies not only that I am ignorant, but that I am so ignorant that I can't possibly be anything but ignorant. It also implies that the person saying it has some clairvoyant understanding of what it is that I know. Perhaps some well-meaning people have said that with the best intentions, but I'm far more inclined to agree with SHU-CH on this. I've always heard it from insecure people using it as a way to keep others "in their place". Of course, this is a reflection of my training to this point...maybe the PA experience will be different. Link to comment Share on other sites More sharing options...
db_pavnp Posted August 11, 2015 Share Posted August 11, 2015 A good wordsmith is needed to generate an equally short, catchy, and highly offensive way to turn this phrase back upon anyone utilizing it. Link to comment Share on other sites More sharing options...
Guest JMPA Posted August 11, 2015 Share Posted August 11, 2015 "ignorance is bliss" "what you don't know can't hurt you" " if it isn't known, does it exist?" All aside, there are very real known unknowns. The important thing is not to know everything but how to locate what you need to know. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 11, 2015 Moderator Share Posted August 11, 2015 A good wordsmith is needed to generate an equally short, catchy, and highly offensive way to turn this phrase back upon anyone utilizing it. so "FU a$$clown, I was running codes the day you were born" is inappropriate?.....:) Link to comment Share on other sites More sharing options...
WWUViking1983 Posted August 11, 2015 Author Share Posted August 11, 2015 Hahahahaha EMEDPA!! As a fellow EMS grunt, that was precisely my idea of a clever reply! Cheers! Link to comment Share on other sites More sharing options...
SHU-CH Posted August 11, 2015 Share Posted August 11, 2015 so "FU a$$clown, I was running codes the day you were born" is inappropriate?.....:) You'll never believe this, but I swear it is true: I am a second year PA student on a medicine rotation and hear a code called for a patient I was following. I get to the room and two residents are there. I am still not exactly sure what happened, but I think the patient was in respiratory arrest. One of the residents says "Ok, I have a femoral pulse around 60." Resident number 2 says, "Ok I am going to shock him" and pulls out the paddles and starts charging them. It's like being in a Salvador Dali painting. Our program made us all take ACLS before rotations, so the lowly PA student in the room says, "Hang on - you are going to defibrillate a patient with a palpable pulse of 60?" Now the two of them stand there staring at each other befuddled for about 30 seconds and an attending walks in. I guess they didn't know what they didn't know. I'm glad they had all that extensive basic science training in things like embryology and immunology, though... Link to comment Share on other sites More sharing options...
Glorious_Ignoramus Posted August 11, 2015 Share Posted August 11, 2015 Pro tip: stay off of SDN. There are those who frequent both this site and SDN and nearly always come out on the wrong end of the never ending, useless debates and pissing contests there. It's nothing but a bunch of disillusioned pre-meds, nothing to learn there, move along. Link to comment Share on other sites More sharing options...
UGoLong Posted August 11, 2015 Share Posted August 11, 2015 FYI. The person who says you don't know what you don't know also doesn't know what he doesn't know. It isn't a pejorative at all. Every project team I ever worked on tried to structure their development work accordingly. Link to comment Share on other sites More sharing options...
AREID Posted August 12, 2015 Share Posted August 12, 2015 Not sure what all the negativity is about, but this is about life. This doesn't only pertain to the PA profession. There are three levels to education (regardless of what you study) 1. you don't know what you don't know 2. you know what you don't know 3. you know - no one ever really gets here... Regardless of what it is you study, you're not going to know everything and your not even going to know what you don't know. I know you're probably wondering what the heck I'm talking about. lol. Thing is until you have been put in a variety of situations, certain diseases or presentations (to keep it relevant to medicine) won't even pop into your head, simply because you haven't been exposed. After a while, you'll have seen and done enough to know that something is out of your hand and you should get help. If you ever reach phase 3 - consider yourself the authoritative expert (but even as we know they don't know everything either). This is not a doctor bashing a midlevel. This is simply comparing an expert to an amateur. But, as the saying goes...every artist was once an amateur. Hope this helped :) Link to comment Share on other sites More sharing options...
DejaBlu Posted October 15, 2015 Share Posted October 15, 2015 This applies to every single person out there, no matter their profession. Nobody knows everything!! Don't let it bother you. And, if it's meant as an insult just be glad you're not as ignorant as the person that said it to you. :-) Link to comment Share on other sites More sharing options...
adru373 Posted November 24, 2015 Share Posted November 24, 2015 All new people "don't know what they don't know." That's regardless of if you're a PA, NP, MD, DO etc. Time and experience change that, your degree will not. Some people are condescending to mid levels. Maybe they had a bad PA at one time, maybe they just don't have experience with them. But most people appreciate the knowledge base of mid levels and seasoned mid levels do often know more than new doctors. Link to comment Share on other sites More sharing options...
KosciuszkoFTW Posted December 1, 2015 Share Posted December 1, 2015 Ah, the hazard phase. Sure- might be true for some NPs/PAs as it's true for some physicians too. It's not occupation-dependent. He may be in the same phase he is referring to (*gasp*). Link to comment Share on other sites More sharing options...
JohnnyM2 Posted December 1, 2015 Share Posted December 1, 2015 If a doctor says "PAs and NPs don't know what they don't know", isn't that a hurtful micro-aggression that creates a hostile working environment for these folks? Sent from my SM-G900V using Tapatalk Link to comment Share on other sites More sharing options...
whoRyou Posted December 1, 2015 Share Posted December 1, 2015 Ah, the "I'm an expert phase". Sure- might be true for some NPs/PAs as it's true for some physicians too. It's not occupation-dependent. He may be in the same phase he is referring to (*gasp*). So, does this mean WE know nothing at all, or at least not enough? Unfortunately, the real world often doesn’t make sense. In the real world, people don’t act rationally. It may seem like they do from the outside, but if you dig deep enough, you’ll find it’s usually an illusion at least IMO. WE as a whole hopefully after many trials and tribulations should know a lot more than NOTHING, or so WE hope so - OR NOT. Link to comment Share on other sites More sharing options...
KosciuszkoFTW Posted December 1, 2015 Share Posted December 1, 2015 So, does this mean WE know nothing at all, or at least not enough? Unfortunately, the real world often doesn’t make sense. In the real world, people don’t act rationally. It may seem like they do from the outside, but if you dig deep enough, you’ll find it’s usually an illusion at least IMO. WE as a whole hopefully after many trials and tribulations should know a lot more than NOTHING, or so WE hope so - OR NOT. Missed the point. The /actual/ expert phase isn't about [not knowing anything at all], it's about humility and realizing there's always much to learn about any given subject (and that's okay). Link to comment Share on other sites More sharing options...
whoRyou Posted December 1, 2015 Share Posted December 1, 2015 Missed the point. The /actual/ expert phase isn't about [not knowing anything at all], it's about humility and realizing there's always much to learn about any given subject (and that's okay). Boy I sure did ... LOL And by the way I do agree there is ALWAYS much to learn about any given subject. I always say, I am the student, not the teacher Link to comment Share on other sites More sharing options...
JohnnyM2 Posted December 8, 2015 Share Posted December 8, 2015 Boy I sure did ... LOL And by the way I do agree there is ALWAYS much to learn about any given subject. I always say, I am the student, not the teacher Yeah, I'm not even sure I know what I know so how could I possibly know what I don't know. Wait, I'm getting confused...what was the question? Sent from my SM-G900V using Tapatalk Link to comment Share on other sites More sharing options...
Guest JMPA Posted December 8, 2015 Share Posted December 8, 2015 those that don't know but think that they know are fools those that know but don't know that they know are asleep those that know and know what they know and know what they don't know are truly wise indeed Link to comment Share on other sites More sharing options...
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