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!


Anonymous said...

When I was diagnosed with early stage cancer (2008), I thot fine get surgery done & move on, but CT scan revealed another tumor (rare) elsewhere & the specialist says deal with the 1st, the rare one can wait. God knows the 2months wait was full of unanswered zillion Q&A which was I got from DrGoogle ! I mean having cancer & then being made aware I may go on to have autoimmune related illness how much can one take ? I'm glad my doctors didn't specifically gave me a definite answer then (two pre-ops) coz it will make me feel worse. I thank my 2nd doctor for that coz he says don't believe all that is written/published. I'll deal with what may come next & stand up to it.

Helen said...

This isn't nearly as life-altering an issue, but I can relate to a certain extent. There's been a lot of dispute between my doctors over whether or not I actually need the defibrillator I had implanted two years ago. I think, finally, my primary cardiologist realized I was finding the whole debate stressful, and that I need to believe there was a point to the surgery and the complications I had afterward. He told me that he thinks I made the right decision and he'd have done the same.

I know the answer isn't cut and dried, and he didn't have to say what he did, but it means a lot to my sanity to believe I made the best choice.

Anonymous said...

I made my surgeon give me a pep talk once. And he wasn't the best with the people skills either. Hey, I was desperate. After surgery, weeks of cast + crutches, weeks *off* the crutches+cast and still barely able to walk and I was frustrated. So I made him tell me I'd feel better soon. He did. It worked.

Anonymous said...

Huh. I just saw my cardiologist about my very rare aorta defect. He said he would research it and "take care of it." I found it really reassuring. Because really no one knows what to do with me, but I know I am sure sick of living with constant respiratory infections. So for now I think "Oh, he's taking care of that right now." It's nice. What I needed to hear when my brain was going in circles trying to figure it all out.

Pissed Off Patient said...

I see your point, but I will say the dynamic you describe is quite paternalistic and denies patients the full ability to participate in their care.

Better communication would have been 'I know you are concerned. I think he will be fine and running around like any other child. Let's see how xyz goes between now and the follow-up.'

I really dislike how doctors withhold information. While it probably makes me less of a pain in the ass, it also disempowers me and reinforces a dysfunctional power dynamic between doctors and patients.

If someone is asking a question, they deserve a thoughtful response.

But I think the medical profession has serious communication issues that really aren't the patients' problem. Seeing the notes from my daughter's specialist visits and how they completely don't match our appointments has been eye opening. The discrepancies are scary.

I don't even want to see my medical documentation. It would probably make my head explode.


Doctor D said...

Good thoughts "Pissed off Patient." Paternalism is an interesting concept that I've never addressed here before.

It is a difficult request to ask that a doctor never "withhold information" or allow a "power dynamic."

If knowledge is power then the doctor's power compared to the patient immense. Even intelligent patients haven't gone to medical school and therefore would have a hard time understanding most of what is on the doctor's mind.

In this situation I actually had gone to medical school and still the field of knowledge was so esoteric and specialized that I couldn't really comprehend the issues involved.

I'm not exactly sure how he could "empower" me when there is a huge knowledge difference and he only has 15 minutes for the whole appointment.

Paternalism isn't a dirty word. It isn't ideal, but it works. Empowerment and shared decision-making really is the ideal, but it is hard to make happen in the hectic real world of medicine.

Christine-Megan said...

Working in BMT, I get a constant stream of questions. "Why am I still feeling well?" "When will I feel sick?" "When will I feel better?" "Will I get mouth sores?" "Do people with my condition do well?" "What sort of length of stay can I expect?"

My reply is always, "There's no way to know, everyone is so different." When I say that, I'm being totally truthful. I'm not dodging questions. It just truly is unpredictable. I've seen LOS's from 15 days to over a year. I've seen people get no mouth sores, and I've seen people intubated for airway protection as all of their mucous membranes slough off in a bloody mess. I've seen people go through their whole initial stay with no symptoms. I've seen people die after 2 days in the hospital. Even people who have more than one transplant experience totally different things each time.

It's frustrating, because people want and deserve answers, and I hate looking like a babbling idiot when I tell them I have no way of knowing.

Anonymous said...

You know though, doctor (and other people) who can say "You know, I don't know the answer to that" are the ones I trust and keep. Because I figure they have enough confidence to live with some uncertainty, and enough humility to tell me that.

tracy said...

Dr. D, i am so glad Little D is doing fine. Is that a picture of him as an infant? Cute, whoever it is!

Your story reminds me so much of Dr. Atul Gawande's, being a Physician in the situation of having a sick child. So many similar feelings. He came to the point where he just wanted the Physicians to make the decisions.

Doctor D said...

Yeah, Little D is a cute little bugger!

The crying baby as well as the toddler in my arm at the beach are real pictures of the kid.

His mom and I need to look at pictures these days too, because the actual boy is usually moving too fast for us to get a good look at him.

Anonymous said...

Awww... Doctor D., you did it again. You warmed my heart and helped me put my doctor-patient relationship in perspective. Thank you Big (and little) D! You'll make it through the twos, I promise. Plus the threes are worse and... I feel for you as you go through the amazingly wonderful parenting experiences with a completely irrational little being.

Your fan,

Anonymous said...


First let me state that I have chronic intratable migraine/New daily persitent headache as well as severe dysautonomia. I am also the child of two very smart physicians. When the headaches were first diagnosed, my parents had just enough ok, more then enough knowledge to drive doctors crazy. I noticed that one Medical Institution had a novel way of dealing with this- under my name on the conver of the chart was written in capital letters: WARNING: PARENTS ARE PHYSICIANS. (It also listed dates of graduation as my mother attended medical school there and my father completed his residency at the same institution.} It basically gave the attending doctors a heads up and the ability to dodge with dignity. They had the correct diagnosis, encouraged me not to give up and gave my parents piece of mind. So yes, dodging is fine.


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