Not Knowing What You Don’t Know: Is Ignorance Ever Bliss?
As I see it, there are two aspects of “not knowing what you don’t know” as applied to health and medicine. One is related to the behavior of the physician and the other is related to the behavior of the patient.
A physician who does not know what information is missing from his or her medical knowledge or understanding may be diagnosing and treating patients with a mental blinder. Doctors simply cannot know about everything clinical and indeed there is some information that is simply unknown to all professionals but all physicians should be aware of these unknowns. A physician assuming that he or she is aware of some knowledge but doesn’t really know is in fact performing guessing and then to proceed without being aware of one’s ignorance of some element of diagnosis or treatment can cause damage to the patient through possible subsequent error. Also without knowing what the doctor doesn’t know, the doctor can be delaying a consultation on the case by a physician whose medical knowledge is more complete in the particular information.
How does “not knowing what you don’t know” apply to the behavior of a patient? It does apply but in a different meaning and context than that of the physician but can be just as potentially harmful to the patient.
A person who is without symptoms and is unaware that they have tuberculosis may be made aware of the disease by skin tests and chest x-rays. If that person would agree to take these tests as an appropriate screening the person would then know and could be promptly treated. But what if a patient doesn’t want to know what is yet unknown to the patient? If a patient has trouble swallowing but fears that cancer is the cause, the patient may elect to delay going to the physician for a diagnosis, fearing the worst. By “not knowing” what is yet an unknown there may be some temporary comfort to the patient by the ignorance than being aware of the diagnosis of cancer, if present, but that would be delaying final diagnosis and treatment of whatever was causing the symptom.
I have written above that either the doctor or the patient “not knowing” can be harmful. Are there any reasons in either application of “not knowing what you don’t know” to the physician or to the patient could be accepted as something appropriate and an ethical “good”? Is ignorance ever bliss? ..Maurice.