Strength and Weakness
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By Puxiao Cen, M.D. | Published May 2007

The field of medicine has progressed and grown in range and scope over time. There once was a time when every doctor was a general practitioner and there were no specialists. Now there are dozens of specialties and subspecialties. This reality does not always transfer directly to the expectation of patients and doctors. While we acknowledge that “know-it-all” is impossible, this fantasy expectation sometimes becomes the source of discontent for both patients and doctors.

Often times a patient wants his or her physician to be knowledgeable in a broad spectrum of topics, ranging from morning sickness to cancer, while simultaneously having the depth of skill to perform open heart surgery. Since time and resources are limited, it is all but impossible to be a master of all skills and knowledge. Whenever one makes a decision or chooses a path, one inevitably relinquishes other options.

There are times when a patient will ask me a non-cardiology medical question such as about the diagnosis and treatment of a skin rash. While I have many joyous moments every day from saving lives by fighting heart attacks and congestive heart failure or feel rewarded when I see my patients cholesterol level or blood pressure being lowered successfully, I also hear the disappointment in some of their voices after I tell them that the specific skin rash is beyond my scope of expertise. Deep down I am dissatisfied with myself too when I have to admitted, “I don’t know”. After all there is a modicum of personal pride because I went through three years of Internal Medicine training and am still board certified in Internal Medicine. That should mean that I am able to help my patients with some common ailments. However, since I have decided to focus my practice solely on Cardiovascular Disease, my knowledge of other areas has atrophied. The old adage “use it or lose it” really applies to knowledge. There is even a television show based on this premise called “Are You Smarter Than a 5th Grader?”

Acknowledgement of this fact of life does not make it any easier to accept. I am not happy to know that I have become more and more outdated in other areas of medicine. Even though I constantly read Internal Medicine journals in addition to the Cardiovascular Disease ones, it is not as effective because I do not have the opportunity to practice the application of that knowledge on a daily basis. As logical as this seems to be, it is still difficult to accept. When your job is to serve the health needs of your patients, at least that is what I think of myself, you feel inadequate when you say no to the hand reaching you for help.

This phenomenon carries over to personal life as well. We give people certain titles or labels that carry certain expectations. This makes it equally difficult to avoid being critical to oneself. As a mother and wife, I place certain expectations and duties on myself. Doing homework with our son, organizing our home, and cooking fall under the usual expectations for a wife and mother, however, they have never been my strengths. My husband is truly an ideal husband and he is very attentive to our 14 year old son’s academic achievement, maintains a beautiful house and garden, and produces several Chinese dishes (even though he is Scottish). While he never complains about our roles, I often cannot stop saying “I am sorry for not being a traditional wife to you.” We all have unrealistic expectations or ourselves and others. I guess since each day is only 24 hours and we cannot live forever, we should not expect anyone to have unlimited knowledge or abilities.

Still, if only I knew a little more about that skin rash…