It’s too soon to tell.

“It’s too soon to tell.”
I don’t say it very often, but I’ve learned through experience that sometimes it’s the right answer. My crystal ball worked the best right after I completed my training, but Mother Nature has humbled me several times since then, and now my crystal ball doesn’t work so well. It’s not a pleasant experience to promise parents that things will work out fine, and then they don’t. And on the flip side of the coin, it’s almost as bad to predict problems that never arise. Of course parents are happy that the worst did not occur, but they are justifiably upset at the unnecessary anguish I have put them through.

When the exam is ambiguous, the doctor’s challenge is to resist the feeling “I need to have the answer, and I need to have it right now.” This feeling is not just a reflection of the parents’ wish to know (after all, they came to me in the first place because I’m the consultant, the Mighty OZ who sees all and knows all). There’s a deeper level to the problem: From the time we entered school, we’ve been trained to put up our hand when we know the answer, and the one who gets the answer first is the winner. “I know! I know!” the first-grader exclaims, thrusting his or her hand into the air. The same emphasis on having a quick answer underpins all the timed exams that doctors have taken over the course of their careers. To be sure, there are some medical situations in which speed is vital: CPR, for example. CPR is akin to atomic physics, where particles collide in microseconds. Child Development, on the other hand, is more like geology, where mountains form over millions of years. (The reason I avoided Child Development in my training as a pediatric resident was because of my misperception that “nothing happens.” I was just using the wrong time scale.)

So, what’s the right thing to do? Let’s get back to OZ for a moment. Remember the scene at the end, where the Wizard confesses to the Cowardly Lion “I am not a wizard. I can’t give you courage… But I can give you a medal,” and to the Scarecrow “I can’t give you brains, but I can give you a diploma,” and to the Tin Woodsman “I can’t give you a heart, but I can give you a watch.” Each of Dorothy’s friends is buoyed by their gifts, and in fact the lion becomes brave, the scarecrow becomes wise, and the Tin Woodsman declares (as Dorothy bids farewell) “Now I know I have a heart…. Because it’s breaking!” I am no wizard either. And there are times when I can’t give parents “the answer.” But I can always give them a plan – what to do right now, and from this moment until the next visit, when the diagnosis may become clearer. “It’s too soon to tell” is an acceptable answer, but it’s never appropriate to say “Let’s just wait and see.”