You Only Know What You Know
Reflections on clinical experience, competence and the importance of recognising our limitations.
There is something I regularly say to students I teach:
“Remember, you only know what you know.”
It sounds obvious, doesn’t it? But I believe it is one of the most important lessons we can learn as healthcare professionals.
After 17 years working as a physiotherapist, I am perhaps more aware than ever of just how much I don’t know.
That might sound surprising. Surely experience brings knowledge, confidence and expertise?
Of course it does. But experience also brings an appreciation of complexity, an understanding of uncertainty and, perhaps most importantly, an awareness of the limits of our own knowledge.
And in healthcare, recognising those limits is fundamental to safe practice.
Confidence and competence are not the same thing
Throughout our careers, we develop knowledge, skills and experience. Our competence evolves as we encounter different clinical situations, undertake further training and learn from colleagues and people we treat.
But competence isn’t simply determined by how many years we’ve been qualified.
It depends on our knowledge, skills and experience in relation to the particular situation we’re facing.
We may be confident managing one presentation, but considerably less experienced with another. And that’s perfectly reasonable, provided we recognise it.
The danger comes when we don’t recognise the limits of our own competence.
Asking for help is a strength
One of the messages I try to reinforce with students is that knowing when to ask for help is not a weakness.
Neither is recognising that another professional may be better placed to support the person in front of us.
Seeking advice, discussing a case, referring appropriately or signposting someone towards another service are all important aspects of responsible clinical practice.
We don’t have to know everything.
But we do have a responsibility to recognise when we don’t know enough, and to act accordingly.
Competence will develop throughout our careers. What we are equipped to manage today may be very different from what we were equipped to manage five years ago.
The important thing is working within our competence at that moment in time.
We are detectives
I often think of physiotherapists as detectives.
We listen, observe, ask questions, examine and gradually piece together a clinical picture.
But the picture is rarely complete at the first appointment.
Sometimes new information emerges. Sometimes symptoms change. Sometimes we learn something about a person’s circumstances that causes us to reconsider our initial thinking.
We are continually assessing and reassessing.
And we should be prepared to change our minds.
I often tell my own patients:
“Don’t worry if you go away and remember something you’ve forgotten to tell me. Bring it along next time.”
Because the story can develop as we get to know someone.
Of course, that doesn’t mean waiting when there are signs that require urgent attention. Appropriate safety-netting, recognising concerning changes and knowing when further assessment or referral is needed remain essential.
But it does mean understanding that clinical reasoning is an ongoing process, not simply something we complete during an initial consultation.
Experience should make us curious
One of the things I value most about clinical experience is that it has taught me to remain curious.
The longer I practise, the more I recognise that patients don’t always fit neatly into diagnostic categories or follow predictable recovery pathways.
There is almost always something more to learn.
And I think that’s a healthy place to be as a clinician.
Confidence is important, but so are humility, reflection and the willingness to question our assumptions.
We should never become so certain of what we think we know that we stop looking for what we might have missed.
A final thought
After 17 years in physiotherapy, I still learn from my patients, students and colleagues.
I hope I always will.
Because perhaps one of the most important things experience teaches us is not simply how much we know, but how much there will always be left to learn.
You only know what you know.
And recognising that is part of being a safe, thoughtful healthcare professional.
