How do you know that?

There are several lessons I’ve learned in my life that stand out. Nothing worth doing or having comes easy. Little good can come from being out after midnight. (Thanks, Viola.) Stay out of debt, never lose principal, and you make your money on the purchase side of the equation (you have to get the right price to have any hope of a decent return on investment). And to quote The Princess Bride, “Never get in a land war in Asia.”

But the lesson I think of over and over came one morning during residency. I was six months in to my rotating internship, and had worked an exhausting thirty-six hours shift at the university hospital on green team medicine. Overnight, I had responsibility for eighteen admissions. That morning after thirty minutes of interrupted sleep, I stood praying I could recite the pertinent issues correctly for my share of the sixty plus patients on our service. I knew I would be asked by our attending physician, and I was not disappointed.

We were asked a question regarding the proper initial medication and dosage for community acquired pneumonia. It seemed like a simple question. We all answered penicillin G aqueous. We all knew the answer and felt sure of ourselves. After all, we had heard this mantra repeated over and over by other residents with greater experience. Our attending looked at us with a patient expression and asked, “How do you know that?”

It was a simple question, but as I thought on it, the only answer was that I had heard the answer from other apprentice physicians, but I couldn’t quote any other source. You can guess what he said next. The answer was Erythromycin. We had all answered wrong. He invited us to look it up. Now, in 1986, there was no hypertext learning. There was the library, and papers, and books. Of course, he was correct.

Every day, week, month, and year since that moment, I have remembered that simple lesson and tried to take it to heart. Never make an assertion without a reputable source, preferably several. Avoid make an assumption. Be patient. Gather the evidence. Do the homework. Never believe what I’m told without fact checking for myself, especially when it runs against common sense or my core principles.

That morning, beyond exhaustion, I was given a gift. Priceless wisdom that helps for almost every decision in life and is ignored only to peril. I’ve said thank you many times in private. I would like to say it one more time.

Thank you.

Peace be with you.