Dec 8, 2010

Time Out

Last year Dr. D took the season of Lent to unplug from the internet for a while and contemplate the deeper meaning of life. It was an invigorating time of growth and reflection...

Yeah, you guessed it, Dr. D is putting his blog on "timeout" again.

We're going to pause AskAnMD for 2 months. Dr. D still has a lot of great stuff to blog about, but for now he just doesn't have the time. We'll be back sometime in February.


My grandmother as well as my favorite former patient died in November. This got me thinking... Dr. D keeps a list of things to do. That list included: "Call the Dude" and "Visit Grandma D" for many months. I procrastinated even when I knew the end was near for both of them. I could have reached out to either of them while they were still alive, but I was too busy.

Grandma D:

I love this blog, but it takes a lot of my time. I spend a lot of time thinking on the questions you write me, and writing, re-writing, checking, and formatting a post takes about 6 hours for me. Yeah, I'm that slow!

Going faster would make me put out rambling, useless junk, and I wouldn't do that to my readers.

So posting every week takes a significant chunk of my free time. So for the next few months I've decided to allot more time to my friends and family who are still breathing.

I Shall Return!

Doctor D will be back in his online clinic of doctorly wisdom and sarcasm soon, but for now you'll have to survive the long nights of Winter without him.

But be of good cheer! There are lots of great medblogs out there to keep you entertained and informed. The ones listed on the blog roll to your right are an excellent place to start.
You can also catch up on some of the really awesome stuff in the AskAnMD archives, and if you get board and desperate for a fix of Doctor D's inane observations you can follow him on Twitter.

You can also still email Dr. D your questionsjust don't expect any immediate answers.

Then sometime in mid-February just when you had almost forgetten about Doctor D your feed for AskAnMD will roar to life and bring you awesome insights on that will totally blow your mind!

Until then:
I love you guys!

Merry Christmas, Happy New Year, and all that other cheerful holiday whatnot!

Nov 29, 2010

The Doctor Will Grope You Now

Doctor D, what are your thoughts on the TSA?
Okay, so no one actually emailed me this, but it’s high time Doctor D set things straight!

Dr. D’s prescription for America:
Stop being such snively, self-important, brats!
So what gives a medical doctor any right to speak on transportation and counter-terrorism?

Doctors also do full body searches. We call them physical exams.

During these exams we touch and look at every part of the body. I stick my fingers in vaginas, rectums, and mouths. I even sometimes do these exams on children—Oh, the horror! Lock up that sick man!!!!

How do doctors get away with this disgusting violations of your rights? We feel you up under the guise of keeping you safe. The TSA learned their trick from doctors!

These exams are theoretically voluntary, but most doctors will decline to take care of you unless you submit to some sort of medical pat-down. What an outrage!

Is All Touching Dirty?
Look, we all recognize that this is a weird situation. Touching a stranger’s body is awkward for both the toucher and the touchee. It is human nature to reserve close physical contact for family, intimate friends, and lovers. But sometimes we must do things that feel unnatural.

It is my job to touch every person who seeks my help.

Sorry, but when we spend all day touching bodies we kind of get used to it. You may see your body as a unique and private expression of yourself, but we see it simply as a dull object that must be checked for signs of danger.
You may feel violated because I had to check your prostate, but it didn’t bother me one bit. Checking your rectum is no more disturbing to me than checking your ear.
Of course, we try to be sensitive. Doctor D has had to do some invasive exams on little kids and sexual assault victims. We should take our patients’ feelings into account, but not not doing our job at all isn’t sensitivity—it’s incompetence.

Here's The Naughty Part
(Stop here if skimming!)
What everybody's getting really worked up about is genitals! You only let people touch those in the most intimate of moments, except of course at the doctor’s office or the airport. Then you get a stranger poking around some sensitive spots.Doctor D will go ahead and answer your question now:
No. We are not thinking about sex, and if you are that’s your problem—not ours.
We aren’t eunuchs or anything like that—we are just focused on the job. Doctor D is a red-blooded heterosexual man who loves women as much as the next guy, but D can honestly say he has never once felt anything amorous about a patient during an exam. You could be a supermodel or an 80 year old grandmother and Doctor D feels exactly the same about touching you during an exam. Doctors learn quickly to see the bodies we work on as tasks to be completed rather conduits of passion.

Sure there is the occasional true sicko, but these people so rare that you chances of having one of them examine you is pretty minuscule. Doctor D has known quite a few doctors who were walking hormones and hit on everything of the opposite sex they ever met, and still these docs were nothing but professional and trustworthy when doing physical exams. A professional touching of the private parts is about as unromantic a situation as possible.
The attracting effect of the human body has no power over me when I wear the white coat! "Sorry, but I just don’t feel that way about you. It’s not you—it’s me"

Can We Handle This Like Grown-Ups?
I feel for the TSA agents. They are getting harassed for just doing their job. Physical exams suck. I’m sure pat-downs do too. But if they are necessary in order to ensure your safety and they are required to fly, then you should either grin and bare it or plan a long road trip.

This TSA fiasco irritates Doctor D to no end! It’s not that people dislike body searches. That is understandable. It’s the attitude of enraged entitlement that irks Doctor D. Everybody demands everything be done perfectly, safely, and cheaply and with no inconvenience to them whatsoever:

“I feel bad! I demand your full attention. Don’t make me wait; don’t poke at me; and don’t you dare tell me the treatment has risks or side effects! I have a constitutional right to everything I want right now and without any bother!”

And we wonder why the rest of the world thinks we are spoiled assholes?

Doctor D will be flying over the Christmas holidays, and when it’s time for his pat-down he will thank the beleaguered TSA agents for keeping us safe.

Your thoughts?

Any of you out there who's had a TSA pat-down that thinks it is worse than a pelvic exam?

Do you think patients should get treatments they want while “opting out” of the physical exam?

While Doctor D always loves to hear your thoughts, if your comments are too whiny or bratty Dr. D will hunt you down and administer a punitive rectal exam!

Nov 13, 2010

Growing Up Sick

A teacher asks Doctor D about a diabetic teenager in his class:

“His sugar readings are often over 400. His mom says this is normal. Can this be normal?”
Before we start Doctor D has to throw out his usual disclaimer: No medical treatment advice shall ever rear it ugly head in this post! Okay, I feel so much better! Now on to normalcy:

What is NORMAL?
a) A state of harmony within the body and mind that leads to health and well-being.

b) The typical or status quo for a person; the way things usually are. [eg: “Doctor D’s weekly posts are normally late.”]

c) WTF? There is no such thing as "normal" for a teenager in the clutches of puberty.
I’m guessing that mom meant something between B and C.

The Trials and Tribulations of Puberty:

The teen years are some of the toughest in a life. You suddenly realize that you are no longer a child and find yourself drowning in a sea of raging hormones. You don't want to hear your parents advice or follow their rules, you are desperate to fit in with your peers, you feel invincible, and you can’t wait to take risks (especially the ones adults tell you not to). The only people more stressed than teenagers are their parents.

Now add to a chronic illness to all the “normal” teen drama and you have a really volatile mix! If having a chronic illness and being dependent on doctors, tests, and treatments can push even a stable, well-adjusted adult to the limit, just think of the havoc it can wreck when you are 13!

Type I Diabetes is a perfect example of this:
Patients are often diagnosed as small children. They often don’t remember a time they weren’t constantly counting carbs and taking insulin under their parents direction. Doctor D has seen it again and again: a diabetic kid does fine until about 13 when they suddenly decide they have to live a “normal” life. The teen acts as if there is no illness and begins ignoring all the rules that keep them alive. In my experience chronically ill teens have difficult identity issues and can be in dangerous denial about the seriousness of their illness.

Parent during these times get frustrated and burnt out. The harder they try to manage their teen's illness the more the child resists.

"I SAID take your insulin!!!!"

These power struggles between parents and teens happen in most homes, but when the teen has a serious chronic illness the tension can rise astronomically!

So why did mom say everything’s okay?

Parents of chronically ill teens often feel helpless and very guilty that they cannot protect their kid's health the way they used too.

A teacher asking about his illness could be a very sensitive issue for the the teen and the parent. I can understand the mother just answering "oh that's normal for him" to avoid discussing the extreme stress and difficulty of the situation.

Sometimes when everything’s going to hell in a handbasket it’s easier just to pretend we’re all fine.

So you really want to help?

But if you know things really aren’t fine, and you’re someone like a relative, teacher, doctor, counselor, friend, etc. you really should try to help the frustrated family.

Here’s how you offer assistance without making things worse:
1) You must be sensitive to what the teen and the parents are going through. If you act like you are just going to ride in on your white horse and save everybody you will get shut out by the parents and teen pretty quick. (Doctor D has learned that one the hard way!) Start by acknowledging how difficult the situation is to both the teen and the parent.

2) Make it clear that you will protect their privacy. The teen should know you won’t embarrass them in front of their peer by exposing their illness against their will. The parents should know you won’t shame them as bad parents because their teen’s care isn’t working.

"Embarrassed? Us? No way! We're like the the smoothest guys we know. ...did we seem embarrassed? Because we totally aren't."
3) Talk to them like they are normal. (Normal definition A) Even sympathy can be irritating and isolating for a family dealing with chronic disease. Talk to the teen and the parents like you are talking to normal people dealing with normal problems.

4) Use your strategic position. Parents and teens often struggle to a stalemate. Being neither the parent nor the teen offers you a huge tactical advantage for breaking the deadlock. Let’s say you’re an adult such as a teacher or doctor. Sure you’re authority figure, but you aren’t the parent therefore the teen is much more likely to listen to your advice about sticking with treatment. So many of the stresses in a teen’s life are social so if you are in or around the social environment you may be in a unique position to explain the stresses the kid is going through to the parents. If you are a peer then you can help the teen "normalize" their chronic illness and see that it’s not something to be ashamed of.

Being a semi-independent semi-adult is a weird state that strains the therapeutic partnership with the parents that previously worked so well for the chronically ill child. As an outsider you can help both parties create the new strategy that will help the young person manage their disease for years to come.

5) Be patient. Unhealthy patterns usually don’t straighten out overnight. Nor do strained relationships between chronically ill teens and their caregivers. Often breakthroughs are followed with setbacks. Take the long view and remember the tumultuous teen years don’t last forever.
Thanks to this awesome reader for caring about his chronically ill student!

Doctor D always enjoys hearing your thoughts in the comments.

Have any of you worked with chronically ill teens or their families?

I know some readers have had chronic illnesses since childhood. How did you successfully navigate your teen years?

Nov 1, 2010

My Favorite Patient Died Today

I just got a call from one of his relatives who found my number in his wallet:

“The Dude” was one of Doctor D’s first patients. He was assigned me when I was a new doc starting out in residency.

The Dude was one of those people that we all go into medicine to “help.” He was poor, and on disability, and had never gone any further than high school. The Dude also weighed about 400 pounds and smoked 4 packs a day, and he hated taking medicine ...and it was new Doctor D’s job to “take care of him.”

Medically speaking, I never was much good for The Dude. He kept doing all the things that eventually lead to his demise. In the end though, it was he that did me immeasurable good.

He actually preferred residents to our better-trained teachers, “I love these new Baby Docs when they come each year!” he exclaimed when he met Doctor D. From then on Dr. D and the Dude were always together. The Dude had a lot of office visits and hospitalizations. He was the epitome of the “difficult patient” and D spent his first year as a doctor stressing about how to save The Dude from impending death.

But it was The Dude who won out. His infectious kindness and joy in the face of pain and illness inoculated Doctor D against the harsh medical world around us.
One day D visited The Dude in the ICU and muttered, “How am I going to save you, Dude?”

The Dude let out a gravelly, smokey chuckle, “You don’t need to save me Doctor D! You’re just nice to me and I appreciate that.”
The Dude is laid to rest

Our doctor-patient relationship evolved over our years together. I did less telling him what to do and more sitting at the feet of one of the wisest human beings I have ever known. The Dude lacked any book smarts, but I know he was brilliant. He understood how a joyful attitude can keep you alive when every textbook says you should have died years ago.

The Dude had about the most unhealthy body and physical habits you can imagine, but he had the healthiest soul of any person I have ever met. He taught Doctor D that there is so much more to life than diagnoses and treatments.

The Dude promised he would try to stay alive long enough to see me graduate from my residency. He ended up outliving his promise by years. I moved to another state after graduation, but we stayed in touch. I was no longer his doctor, but we remained friends.

I took my son Little D on a road trip when he was just a baby to meet my sage friend. It was well worth exposing the kid to a little second-hand smoke. It was like taking your child to be blessed by a living saint.

The Dude and I would write or talk on the phone every couple of months. I started this blog with The Dude in mind. I wanted to answer questions for real folks like him that didn’t give a damn about medical stuff, but found themselves stuck in doctors offices and hospitals anyway. He's the only patient I ever cared for in real life who knew about my secret identity as Doctor D. He read regularly.

We last spoke about 6 months ago. I had “Call The Dude” on my long list of things to do last month, but I never got around to it. I sure wish I’d called my jolly, smokey old friend!

It came as a shock that he's dead—which is strange considering I expected him to die at any moment for the first few years I knew him, but once you really love someone you kind of expect them to live on forever.
Now The Dude is in a place where he has no need for doctors or medicines.

Enjoy heaven, my friend! I wish I'd told you that you were the best teacher Doctor D ever had!

Oct 16, 2010

Warnings and Witch Hunts

An addition to our ongoing series on Incompetent Doctors:

If one of your patients asked your opinion of another doctor whom you know to be incompetent what would you tell your patient?
Incompetence in a physician is a scary thing! Doctors deal with problems of life and death and try to heal you with dangerous tools. A doc that isn’t competent can be seriously dangerous.

But how do you know who’s on their game
and who’s falling down on the job?

It’s tricky for patients because they often don’t know enough about medicine practice to judge competency. This makes putting your body under the care of any doctor scary.

So scary, in fact, that an entire malpractice industry has sprung up to reassure patients that incompetent doctors will be severely punished. Unfortunately malpractice usually ends up a witch hunt that can burn good doctors at the stake and let bad ones go free.

“I saw Goody Doctor D dancing in the woods with the Devil!”
“Tis true! One of his patient died!"
"It can only mean he dabbles in the witchcraft of incompetence”

Wouldn’t it be nice if you had someone who understands medicine who could tip you off on the bad ones?

Yes, but it’s a complicated thing to ask your doc if another doc is incompetent or not.

Judge Not, Lest You Be Judged
Competence is not always as black and white as you might think. There is a good bit of gray and ambiguity involved. The real world practice of medicine involves a lot of educated guessing and trial and error. Even the best doctors occasionally make mistakes or use unorthodox treatments.

The real dangerous doctors are the ones that recklessly disregard patient safety and don’t even care about doing things right. And yes, unfortunately there are lots of doctors like this.

Incompetence may be common, but it is hard to prove. Doctor D occasionally sees signs of suspected incompetence in patients that have been treated by other docs. An incorrect diagnosis or an unorthodox treatment that seems way out of the expected margin of error and puts a patient at risk.

But these clues in the crime can be misleading. Sometimes Doctor D will see something and say to himself, “Self, what this doctor is doing makes no sense. I wonder if he is incompetent?” Later I met the doc only to find that he had an excellent reasoning for what he did, and was obviously acting in his patient’s best interest.

The Medical Gestapo
But there are some doctors that are all too happy to accuse their colleagues of incompetence. These docs believe there is only ONE competent way to practice medicine, and it is the way THEY practice.

These doctors want to be the to secret police who keep medicine in line. They are typically jerks with a massive god-complex. They gleefully tell every patient who will listen which doctors they think suck.

Doctor D has had encounters with the medical gestapo. They shoot first and ask questions later. They see the world in black and white. There is no gray area for them.

“Doctor D you didn’t follow the protocol! Are you thinking for yourself? Are you adjusting the protocol for individual patient's situations? Off to the firing squad!”

Dealing with Dr. Danger
Witch hunts both from within and without medicine have soiled the names of a lot of good doctors. So Doctor D is always careful about fingering another doctor as a dangerous doc, even when he has his suspicions.

I currently know a doc who I am about 70% certain is a walking public health threat. I’ve seen a pattern of “WTF?!” medical decisions that make me highly suspicious that this dude either doesn’t know what he’s doing or doesn’t care.

How certain do I need to before turn Dr. Danger over to be burned at the stake? Well 100% actually.
"We still only have circumstantial evidence, but let's burn him anyway!"

I’ve been a target of the Medical Gestapo myself, and I know how damaging misguided doctor purges can be. I’m not blowing the whistle on Dr. Danger unless I know beyond a shadow of a doubt that he’s really what I think he is.

I’ve only been 100% certain one time before and that time I blew the whistle as loud as I could.

Subtle Warnings
Although I’m not absolutely certain he’s incompetent, I wouldn’t want any of my family seeing Dr. Danger. It would be too much of a risk!

I can’t flat-out denounce him publicly, but I do want to steer patients away from the danger I suspect.

This is where subtlety comes in handy:
I might say "Dr. Danger does some really unorthodox things." Or I might just fail to praise him, while my facial frown indicates I might not be totally cool with Dr. Danger. Or I could just change the subject and suggest you see Dr. Awesome instead.
This is how we doctors subtly steer you away from potential danger.
But you have to read between the lines, because if you flat out ask, “So Doctor D are implying you think Dr. Danger is a totally incompetent fuctard who has no business practicing medicine?” Doctor D will smile and say, “Oh no, Dr. Danger is a delightful person! You have totally misunderstood me!” Then D will give you a wink.
Doctor D puts the B in subtle!

What do you think?

Docs and Nurses: How do you manage doctors whose competency you doubt?

Patients: Do you think you are able to pick up subtle cues from your doctors?

Should Doctor D go gestapo on Dr. Danger?

Any ideas for a better process than this ridiculous system of innuendos and secret winks to keep patients safe? I'm sure there has to be something better.

Oct 9, 2010

It Gets Worse!

So 2 days after Little D broke his leg Lady D his mom goes and breaks hers too! She's never fractured a bone in her entire life and she does it the same week as our toddler broke his. WTF?
So everyone's asking: "Why all these injuries? Does Doctor D beat his family?"
No, of course not! But I might want to look into getting rid of the new seesaw:

This is going to be a long 3-4 weeks in the D-house with them both grumpy and in casts!

Oct 8, 2010

Break A Leg!

No insightful answers this week!

Little D got a leg fracture from over-rambunctiousness, so I've had no time to craft a good post for you guys. Sorry!

"But jumping off the furniture is fun, Daddy!"

Perhaps it's working extra shifts at the hospital and taking care of a fussy toddler on narcotics, but I've posted some kind of harsh responses to some comments recently:
After a very strange tour around the Anorexia blogsphere I posted a very "getyourshittogether" reply to poor JadedChalice's cry for help in last week's comments.

Then I posted an indignant response to indignant accusations that I excuse bad doctoring. Excuse me? Anonymous, you picked the wrong week to mess with Doctor D!
As you can see Doctor D is in no condition to provide any sage wisdom right now. Hopefully next week when he hasn't been up all night with a miserable 2 year-old D will get back to answering your questions brilliantly!

Perhaps some of you could undo the damage of Doctor D's brutal Tough Love Campaign by going back and providing some kinder and gentler responses to JadedChalice and my Anonymous admirer?

You guys are awesome!

Sep 29, 2010

Are Doctors Rich?

(Part of an ongoing series Should I Become A Doctor?)

People rarely ask about income directly, but Doctor D gets a lot of wink-wink nudge-nudge questions about his finances such as,
“So what you drive, doc, a BMW?”


“It’s hard making ends meet sometimes, but you wouldn’t know about that, would you doc?”
So to answer your questions Doctor D will throw open the doors to the secret realm of physician personal finance:

"Where'd I get the money? Med School, Bitches!"

Last year Dr. D made about 150,000 dollars, which is a lot of money. (The Medical Mafia makes sure MD's get paid well in exchange for our souls!) Uncle Sam and student loans took a pretty large chunk of that, but still Doctor D has more than every non-medical person he knows, and he is a Primary Care Doctor, which is one of the lowest paying specialties!

Now before you start filling out medical school applications dreaming of big money let me warn you about the downside: You spend about a decade of your life working for free and amass a mountain of debt to get here.

Dropping Out and Adding Up
Everyone considering the financial benefits of medical school should calculate their drop-out sibling equation:

Doctor D has a brother about his age. Brother D was a smart dude, but he never liked school so he dropped out in high school. Brother D immediately started making money working at low-skilled but steady jobs while Dr. D was toiling away at medical education.

Brother D’s lifetime earning was very gradually rising while Dr. D’s debt was increasing, until one day Dr. D started making big bucks. Dr. D and Brother D sat down and did the math problem.

The answer: 41
Doctor D will be 41 years old before his MD catches up with his drop-out brother's GED in lifetime income!
Our paths diverged at about 17 years old. Doctor D is 32 now so he has another 9 years till he’s made as much money in his life as Brother D.

Medical School isn’t exactly the quick way to riches.

But in this economy who can complain about making six figures? Doctors do it all the time, but nobody is listening.

Doctors work hard and we get rewarded. It just isn’t as rewarding as some pre-med students and patients think.

"You know you laidies can't resist!"

By the way, Dr. D drives the cheapest car Toyota makes—it’s the first new car he ever owned.
What do you think?

Pre-meds and Med Students: Did the financial rewards of affect your career choice?

Patients: Do you think income differences between you and your doctor harms your doctor-patient relationship?

Doctors: Are you satisfied with your income? Do you feel you deserve more or less?

Doctor D always loves to read your thoughts in the comments.

Sep 22, 2010

Saved With A Dodge

Doctor D has dodged some questions in his career, but he has also been on the receiving end of some non-answers and can attest to their usefulness on the patient's side of things.
How the $#@% can a doctor dodging a question help the patient?
Let me tell you a story:

Doctor D’s son Little D was born with a very rare genetic condition which required he see an expert at a big university. As a parent I can tell you that this sucks. Lady D and I did a lot of worrying about our baby.

"Daddy, I don't feel good!"

Medical people are often the worst patients. We know just enough to be really difficult. Or we just know too much, and it gets in the way of our common sense.

Doctor D had never even heard of his son's super rare disease so he read everything he could find. Unfortunately the mutation was so rare that research was almost non-existent. Doctor D read every published study on the disease an found more questions than answers.

The poor Expertologist got way too many questions from Doctor D. Some he answered. Others he totally dodged. Near the end of the appointment Doctor D asked a very specific question about a potential complication.

The Expertologist smiled and said, “Oh, I think he’ll grow up and play sports and have kids of his own some day.”

Doctor D was totally frustrated. “I’m a f*#@ing MD! Of course, I know that this mutation doesn’t affect the reproductive system or the muscles. You didn’t answer my specific question!” Yeah, I considered yelling that, but instead I smiled and left the office.

I still don’t know why the Expertologist gave me a non-answer. Maybe no one knew the answer? Maybe a full answer would have taken a long discussion of probabilities and complex research he didn’t have time for? Maybe he was just sick of this non-expert doctor who asked so many questions?

Doctor D was pissed. But on the way home Doctor D looked in the rearview mirror at his sleeping baby and realized that vague answer had been just what he needed to hear: “Chill out, Doctor D. Your kid is doing fine. He’ll be okay.”

And you know what? Little D is doing just fine.Little D:
Growing perfectly as long as his parents can refrain from killing him during his Terrible 2's

Sometimes patients don’t need factual answers. Doctor D had hundreds of questions tumbling around in his over-educated head. Expertologist could have taken all day answering every question, but the real question was “Is my kid alright?”

This brilliant Expertologist totally dodged even trying to answer my question and told me what I needed to hear, “You kid is okay.”
What do you think?

Have you ever been glad an MD dodged your question?

Do you think there is any place for this in medicine?

Doctor D always loves hearing your thoughts in the comments!

Sep 13, 2010

How To Get A Straight Answer From A Doctor

The answer is really very simple:
Don’t accept a non-answer answer from a doctor on a question that really matters to you!
If you get a dodgy, vague, or useless answer don’t take it lying down. Politely insist that the doctor elaborate and clarify until you get a reply that you understand.

We doctors are totally scary, but if you have to have the guts to ask the question a second or even third time most docs will do their best to insure you get an answer that makes sense to you. Force the issue!

"Okay doc, now I need you to explain that again in plain English."

Sometimes the doctor will have to look something up and get back to you. Sometimes the doc will have to work to explain something complicated in a way that you can understand. Sometimes if there is no definite answer available your doctor can help you understand the nature of the uncertainly.

Most doctors will work hard to get you an answer, but if your doc blatantly dodges your question after multiple direct inquiries you might just be stuck with a god-complex prick. This is good to know so that you can find another physician ASAP who works well with you.

A few tips for truth-seekers:
Be Ready: Medical decisions and predictions can be really complicated. Add the amount of uncertainly that we work with and the straight answers can get really difficult to grasp. Most of the questions we dodge have difficult answers that might leave you with a headache. Don’t assume that the full answer is always going to make things more clear.

Be Reasonable: You shouldn't use the nuclear I-won’t-leave-till-I-get-an-answer option for every question that pops into your head. Doctors don’t mind giving the full answer from time to time, but if you have an insatiable curiosity you may want to do your own research with Dr. Google. You don’t want to be that patient your doctor groans to see because he knows he’s going to end up running an hour behind every time he sees you.

"Doc, suppose my pancreas was a sentient being trying to assassinate me.
How would that change your treatment plan?"

Accept Disappointment: Some patients confuse "a straight answer" with "the answer I wanted." Sorry! You can ask till you're blue in the face but your doctor still has to say, "Your runny nose doesn't need antibiotics" and "90 year-old Aunt Ethyl probably won't recover" every time. Persistence won't change facts, but it may force exasperated docs to tell you a white lie just to make you quit badgering them. You don't really want to force doctors to be dishonest with you.

Consider yourself warned! Use the "nuclear option" with caution. Now go forth and find out what your doc is really thinking!
What do you think? Have you every forced the issue till you got the answer? Tell your experience in the comments!

Doctor D has typically been on the doctor side of this interaction, and can say a patient dedicated to answers always gets them from me.

But do you as patients think this approach works?

Sep 8, 2010

Why Do Doctors Dodge Your Questions?

Before he tells you how to get a straight answers from physicians, Doctor D is going to stall for time by explaining why doctors give vague answers.

Why Would A Good Doctor Give Useless Answers?
1) There is an answer, but your doctor doesn’t know it. Don’t be hard on doc for this one. There is no MD in the world that knows the entire breadth of medical knowledge. Some docs pretend they do. Trust me, they're faking it. While it may not help you "I don't know" is a refreshing answer to get from a doctor. MDs don't often admit this.

2) Your doctor knows the answer, but it is too complicated to explain. A lot of the physical processes doctors think about are pretty complex. Translating all the technomedical concepts into layman’s terms to sensibly explaining it would just take a lot of time and bore you to tears, so the doc just gives you a vague answer instead.

3) The answer depends on a lot of variables. Predicting the course of an illness or recovery can be tricky. A lot of things that are in our control and out of our control can make a straightforward “here’s what to expect” answer impossible. Doctors are busy. It would take a lot of time to explain all the variables. So they often dodge any answer that asks they explain the future.

4) There is no answer. You’d be surprised how many of your questions just don’t have have answers. Doctors have no idea of the answer and no good way of finding out. Sorry! Most patients (and quite a few doctors) get unnerved at the amount of real uncertainty in the world of medicine. We often cover the uncertainty with total bullshit. We make up things that sound intelligent. For example: “Probably a virus...” is secret doctor code for “I have no idea why you feel this way, but it probably isn’t serious.”

"If I tell you it's a virus will you stop bugging me?"

5) The answer went right over your head.
The doctor did answer your question. Doc just said the answer in technomedical jargon that made no sense to you. While you may have technically gotten a "straight answer", the doc replying in a foreign language you don’t speak really doesn’t count.

6) The answer doesn’t matter. "Look, you silly patient, I give out info on a need-to-know basis, and you don’t need this answer!" This is probably the root of all vague, dodgy answers given by doctors. We don’t think the answer is important for you to know. It won’t make a difference. Answers take time and energy that might be spent on something productive. "Trust me, if you needed to know the answer I would have told you already!"

All doctors dodge questions!

Doctor D does it too. Some questions really aren’t as important as others. We are busy and if we took all the time to answer every question we wouldn’t be able to actually help many people with with what’s wrong.

And not everyone wants the full answer:
As a young physician, Doctor D actually tried to fully answer every patient’s question. He looked up answers. He explained complex medical processes and variables. He educated people on uncertainty. And you know what... nobody liked it! Patient’s eyes would glaze over. Doctor D was constantly running late. His patients didn’t always want to get the full answer.

When he switched to need-to-know answering his efficiency improved and his patients were happier. Yes, a lot of people are very satisfied with vague meaningless answers. Not everyone needs the full truth. Some people just needed to know I heard their concerns.
"You want my real answer, or the answer you want?"

But, obviously not everyone is happy with non-answers from doctors. Doctor D’s email is full of desperate patients complaining that their doctors really aren’t answering their burning questions.

So we have a problem:
Full, straight answers to every question would take so much time and energy that the medical system would grind to a halt, but some of your questions need full answers.

Doctor try their best to help filter what answers you need most, but in the end it is only you who can say what you really need to know.
Next Week: Doctor D will teach you how to extract real honest-to-goodness straight answers from an MD!

What do you think?

Are you okay with an MD giving you vague answers or dodging your questions?

Medical People: Do you think it is possible to honestly and thoroughly answer every patient question?

Doctor D always loves to hear your opinions!

Sep 7, 2010

Vague Answers

A reader asks Doctor D:

“What should I do when my doctor’s answers are vague and useless?”
This patient was frustrated that every time she asked her doctor what to expect she got useless answers like “Maybe” or “That’s a great question!” or “I wish I knew” or other replies so vague as to offer no real answer at all.

So D the ever-helpful wrote her back:
Dear reader,

Great Question! I wish I knew. Maybe that’s just how doctors are?

Love always,
Doctor D.
"Admit it, bullshit answers feel so much better coming from a professional like me!"

You know, it's the prerogative to be a heartless bastard that really makes all those years of medical school worth it!
Okay, so Doctor D isn't really that much of a jerk.

In fact, he's starting a series on How To Get A Straight Answer From A Doctor.

Tune in tomorrow for the real answer!

Aug 26, 2010

I Hate Medicine!

Last week Ella the Med Student wrote brilliant and thoughtful advice on how to be happy in medical school: You need to love medicine.

Now Doctor D has a confession to make:

I hate medicine! Medical school was the worst 4 years of my life.
There, I said it! It felt good to let it out.

But before all of Dr. D’s medstudent fans rush to unfriend him on facebook they should know this: Doctor D not just a good doctor. He is a frickin’ amazing doctor!

How is this possible?

They look so pleased just to be in a hospital!
Doctor D isn't in any photos like this.

How I Learned to Stop Worrying and Hate Medicine:
Ella classified medical students based on their love for medicine with the “miserablites” at the bottom. They are the ones in medicine with ulterior motives. Therefore they hate school from the first cut on the cadaver. They don’t fit in with other medical folks. They don’t like studying diseases or treatments. They can’t wait for medical school to be over.

Yup, that pretty much describes D in medical school!

Young D took one of those aptitude tests administered by the college career counselor. It said that his personality was an awful fit for doctoring. He was warned.

So why did he do it?

Medical School With Ulterior Motives
Doctor D’s ulterior motive for studying medicine was that pesky humanitarian impulse. D loves people. As a student young D worked in homeless shelters and volunteered in 3rd World countries—not to pad a resume for med school, but because he actually liked doing those things. Young D asked himself, “Self, what work should you choose that allows you to help suffering people?” Since D had the book smarts everybody suggested medicine.

On day one of medical school D realized he wasn’t in Kansas anymore. He was surrounded by highly driven people who absolutely loved spending 18 hours a day studying pathophysiology and pharmacokinetics. Ella enjoys kicking back with Robbins Pathology while sipping her coffee in the morning. God bless her crazy ass! Doctor D’s trudge through Robbins was about as enjoyable as the Bataan Death March.

D’s secret fantasy in medical school was that one day he’d go in and give everyone the middle finger and drop out. This thought was the only real pleasure he had for most of med school. It kept him going when times got rough. Every miserable day D told himself, “I’ll quit tomorrow.” He came close to doing this about a hundred times, but never pulled the trigger.

Doctoring with Love and Hate
So D became Doctor D, and lo and behold he was right: All this dull medical science he forced himself to learn is useful—it helps sick people get well, and D really enjoys his job!

The actual practice of medicine allows for amazing connection with other human beings. A caring doctor during the worst and most painful day of your life is really useful. Doctor D always gets along well with patients. One reason Dr. D connects so well with patients is that he never really did connect with other medical folks.

Some doctors love studying diseases and reading the latest medical trials—quite a few retired docs do this years after they’ve seen their last patient. That’s cool and all, but it ain’t me. If Doctor D lost his medical license tomorrow you can bet he wouldn’t read another sentence of medical literature again!
"Yeah, I don't like school either, but some things are worth the misery."

But Doctor D does keep up with all the info on the escalating arms race between diseases and medicine and he'll treat you with just as much skill as the next doctor. In some ways D sees himself as the purest form of doctor:
Some doctors battle illness because they are fascinated with the weapons or with the battle strategy. Doctor D fights because he believes in the cause.
So take courage you med school miserablites—you sad souls who don’t like biochemistry or fit in with your anal classmates—here is hope for you yet! You may yet become a fine MD who loves this crazy job in a way those medical types could never imagine.
PS: If any of you med students do decide to go out in a blaze of glory by telling "the man" to stick it up his rectum and burning your student ID please email Dr. D your story because he would love to live that moment vicariously!
An informal AskAnMD poll:

How many of you medical people actually like medicine vs. those who use medicine for ulterior motives like Dr. D?

How many of you patients would care if you doctor wasn’t actually fascinated with your disease and your medicines?

Aug 18, 2010

Will Medical School Make Me Miserable?

Part II of ongoing series: Should I Become A Doctor?

Great question from a potential medical student:

"I got accepted to med school for 2011, but I am scared to commit to this decision. Will medical school suck all life out of me, leaving me passionless, tired and with no ambitions?"
For this question Doctor D called in a consult! Doctor D recruited a real live medical student! Ella the Med Student is a brilliant blogger and a winner of the coveted Big D Award!

Ella's Advice:
Medical school is difficult. It takes tons of time. It's stressful. It is a huge commitment. It's competitive. It is also a million other wonderful things.

Everyone in medical school has essentially the same experience, the same course load, the same time schedule, etc. Yet, you will hear very different opinion from students about their medical school experience... ranging from "it was the worst time in my life" to "this is so much fun!"
The MAJOR factor that contributes to the differences in student's experiences in medical school is why they are there.

"Why am I here?"

Let me describe a pattern I have noticed among medical student. I think there are three main groups of student attitudes about medical school. I'll describe them here...
Ella’s Taxonomy of Medical Students:
The Good
The happiest students are those who are enjoying the journey. They actually love medicine, love the material they are studying, love the lifestyle of continued learning and a high-paced academic environment. Of course, many have other interests and families, but to them medical school is not an obstacle in the way of those things. Med school is an awesome part of their life.

"I'm happier than a pig in mud! Medical school is Awesome!"

Personally, I love reading my huge Robbins pathology book with a cup of coffee in the early morning. I love going to lecture and participating in clinical problem solving. I feel a rush every time I am in the hospital, I talk to my patients for too long, and my brain is always coming up with ideas for projects and research. I look forward to residency and my future career, but I am in no way miserable in school. I absolutely could NOT imagine being anything other than a physician... it took me so much work to get here that I am actually in bliss all the time. I know this sounds weird... but I know a lot of other people like this. If you ask them about medical school, they will describe it just like I have.

The (sort of) Bad
The second group of people are those that like medicine just fine, and it came to it as a reasonable choice. They worked hard in undergrad, and are all around strong academic students. To them, medicine is more of "a good field to be in" but not "the most amazing and only possible career on the planet." They could have been attorneys or engineers or business entrepreneurs or stock brokers and would have been just as happy. They do well academically, but are a bit blase about medicine... often eager to get home, eager to skip extra discussion about a disease or patient, and tend to be a bit frustrated with the rigmarole that comes with medicine. This doesn't make them less of a physician, but they do not enjoy the ride of med school as much as the first group. They are "putting up" with med school... and looking forward to getting out so they can have a family, a paycheck and a steady schedule.

The Ugly
The third group are the Miserablites. They hate medical school. They are barely hanging on by a thread academically, and they are socially and academically absent. They are caught up in the idea that that are in the wrong spot. They've realized that medicine is a lifestyle that doesn't end after medical school... and they expect that stress and academic/hospital nonsense will be a theme in their lives forever.

Some miserablites ended up in medical school because of outside influences. They felt pressured to do something "worthwhile.” Their heart wasn't in it... but they either didn't have another readily identifiable passion, or they felt their other passion didn't hold enough weight.

Other miserablites came to medical school for the money or lifestyle, and quickly figured out that those reasons are not sufficient to motivate you through the insanity of medical school. And they also figured out too late that being a doctor usually doesn't make you rich. 90% of doctors are not free of financial obligations. Student loans, malpractice insurance, etc. make the life less than glamorous.

The miserablites are those who, as you say regard medical school as "sucking all life out of me, leaving me absolutely passionless, tired and with no ambitions." I can tell you I have NEVER even one day felt this way about medical school.

Search Your Soul!
So, you have a lot of thinking to do. I would really consider what this commitment means, and how it will effect your goals. You have already identified some gut feelings about whether this career is a good match for you. I really think you owe yourself, your wallet, your future family, your happiness and your overall sanity some real hard soul-searching.
If you decide not to go into medicine, there is NO SHAME in that!
There are a million other things you can do which are just as rewarding. And if you do choose medicine as a career, choose it because it is best for you. It is indeed a wonderful life, but only if it is the life you really want.

Good luck!
What do you think? Doctor D always loves hearing your thoughts in the comments.

Patients: Would you care if your doctor enjoyed learning medicine?

Medical Students: Where do you fit in Ella's Taxonomy? Any of your Miserablites want to explain themselves?

Go on over to Ella's blog and admire how awesome she is!