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!

11 comments:

WarmSocks said...

If I make an appointment to consult someone for their expertise about a subject, I want an answer.

The more I read on blogs, the more I realize how lucky I am to have the FP that I do. He doesn't assume that I'm too stupid to understand basic information. He sits down and listens, and gives me straight answers. If it could be A or B, he tells me that, and tells me how both conditions would be treated so I know what I'm up against. Once he didn't know the answer to my question; he told me so, then looked it up and gave me the answer the next time I was in. I think I'm going to nominate my doctor for sainthood!

To tell the truth, I was surprised that someone asked this question. I can't imagine asking any of my doctors a question and having them not answer. They've all been great at answering all my questions.

Which is all, I suppose, a very long-winded way of answering your quesion :) No. I'm not okay with an MD giving a vague answer or dodging direct questions.

Pissed Off Patient said...

I think I could handle vague answers IF there was an overarching 'thesis statement' of my care.

Like WTF are we doing here? Someone please tell me. Just give me a theme. A tagline. Something.

Is it 'watch and wait and see if my adrenals kick back on' or 'you're nuts and I'm humoring you' or 'let's see what the blood work says' or what? Give me a direction here.

While we're at it, could I get a straight answer as to whether the way I'm 'doing' prednisone is okay or not? Seems like a straightforward question to me.

I'm absolutely cool with 'I don't know' from a doc. It garners my respect.

But no one ever said I was the average patient either.

M

Doctor D said...

So when I say every doctor dodges questions it doesn't mean that every answer you get from doctors is a dodge. Far from it.

Some patients get no dodges at all. Most get very few. It depends on the patient, and the question, and how far behind the doctor is running.

Anonymous said...

"Doctor D’s email is full of desperate patients complaining that their doctors really aren’t answering their burning questions."

Sorry, I was one of those desperate patients that emailed you, I'm glad I wasn't the only person out there with that concern.

Your response was excellent, but I still wish my surgeon had said something like "The answer depends on a lot of variables" instead of "I don't know" or "That's a good question". I just stopped asking questions - which isn't ever a good thing.

Josiah O. Morris said...

hehe, just wanted to say that I think the first picture and caption is almost on par with "Kiss the ring, bitches!" As always, you're the man, Dr. D!

Linda said...

If you asked your financial adviser a question and he/she danced around the answer, then sent you on your way without any more information than when you arrived, would you be satisfied? The adviser might assume they'd taken care of your needs but you wouldn't be any less worried about your finances. You would just know to look elsewhere for advice.

When people go to the doctor and are given a vague answer, it's often delivered with a liberal dose of condescension. If the doctor didn't make me feel foolish for my query, maybe I wouldn't mind being told that there wasn't a simple answer for my problem. It's not the vague answer as much as the patronizing manner that's objectionable. Of course, we know YOU would never do that, Dr. D.

Helen said...

I think you just crystallized the difference between my two cardiologist. One will actually sit down and give me full, intelligent answers (complete with diagrams!). The other is a master dodger, and he makes if pretty clear that in his opinion, as long as HE knows what's going on, I shouldn't have anything to worry about. Everybody's different, of course, but I definitely prefer the first approach.

Doctor D said...

Linda,

I think your analogy with the financial adviser is actually a good one. I'm sure that financial advisers get asked questions they have to dodge all the time: "So how do financial markets work?" or What will this stock be worth a year from now?"

Now this dude went to school for many years in order to understand markets and make stock predictions, but to explain the complexity or uncertainty required to answer the question truthfully would take more time than it's worth.

So the adviser probably says something like "Markets work by supply and demand" and "It will probably be up" in order to dodge giving you a full answer you don't need and probably won't understand.

It's not a total dodge. The adviser gave you some information, but in his mind he is hiding a lot of info he doesn't have time to share.

Anyone that dodges every question or dodges condescendingly (don't you worry your pretty little head about) like Helen's Cardiologist #2 is a problem, but I'm sure even wonderful Cardiologist #1 does some artful dodging too from time to time.

Anonymous said...

I understand that full answers may take too much time - so provide credible resources where I can find the answers on my own.

And, don't condescend to me - I'm with Helen - a doctor like her first cardiologist won't be my doctor for more than one appointment.

beyondanomie said...

I think I'm going to enjoy reading your blog... I couldn't help a letting out a knowing chuckle or two reading through the list.

I've found one of the most useful things you can do is tell a patient when there is no logical or helpful answer that you can actually give because of the nature of the question they've asked.

It's usually just as quick as dodging the question, because there is no follow-up questioning. Plus, it's honest and clear, so medico-legally safer too. And it builds a better rapport with the patient, making future consultations more efficient too.

Most patients want certainty and clarity, but sometimes our job is telling them that it doesn't actually exist.

That in itself can be reassuring, esp. when you follow it up with what you CAN know/do. It provides an emotional containment around the uncertainty.

kc said...

I absolutely expect a straight answer from my doctor. Even if the answer is that she doesn't know, or that I should go to reputable website X to read up on these three conditions which are all on her short list. I don't expect a rehash of her medical school education. I count myself fortunate to have a rheumatologist who is well aware that many of her patients have already been undiagnosed, misdiagnosed, or blatantly condescended to by the time they get to her, and does her best not to dodge.

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