What To Do If You're A "Bad Patient"

Last post Doctor D explained the sad phenomenon of "Bad Patient Syndrome" to a reader who had been branded by doctors as bad. Today in the Clinic of Dr-Patient-Relational-Awesomeness we shall teach you proven therapies for curing Bad Patient Syndrome:

The Super Simple Solution:

Find another doctor. If one doctor-patient relationship didn't work there are lots of other fish in the sea. Move on!

Knowing there are lots of fish in the sea isn't always comforting!

When the 'Super Simple Solution' doesn't work:

Some people seem to get labeled as a "bad patient" wherever they end up. Within a minute of entering the exam room the doc seems to decide that that you are gonna be trouble. Of course, some patients get this label because they really are irredeemable assholes, but most aren't. Many "Chronically Bad Patients" are just people with difficult or undiagnosable illnesses or a personality that for some reason triggers the suspicion of people with MD behind their name.

So if you are one of the unlucky innocent victims of Bad Patient Syndrome, I am sorry. It really does suck. When the simple answer doesn't work the therapy is going to be longer and harder, but it still can work...

How To Overcome Bad Patient Syndrome:

Don't confront!

If medical professionals' totally wrong impression of you is not grounded in objective reality, then you would think that exposing the falsehood would make it go away. After reading the last post you probably wanted to storm into your doctor's office and yell, "I'm not bad! In fact, I'm a great person. It's YOU who are wrong! Your own fucked-up physician brain that has unjustly labeled me! Dr. D said so on his blog!"

While I'm sure it would feel great to tell off your doctors it wouldn't help. It would likely make things worse.

Confrontation: It won't always have positive results.

Bad Patient Syndrome is a prejudice, and like most delusions prejudice is most dangerous when you try and expose it. Prejudice is subconscious. Docs don't recognize we think this way. Your confrontation or insisting on your innocence only confirms our suspicions that you must be a manipulative asshole.

If you directly attack a delusion it will only entrench itself. You have to work on it subtly until it is the prejudiced person who realizes they were wrong. Your doctor must think they discovered you aren't a bad patient on their own, without any confrontation from you at all.

Dr. D only realized he was labeling people as bad patients after he "discovered" that a few "bad patients" were amazing amazing people after all. In retrospect, I think they were quietly working against my prejudice all along.

Don't act suspicious

Okay, I admit this one is hard. Once you're labeled a bad patient everything you do is suspicious. Doctor's prejudice against you seems to find confirmation in everything you do, but this doesn't mean you have to give us ammunition.

The best way to approach this is to imagine yourself in the doctor's shoes. Ask yourself, "If I suspected someone was manipulative, dishonest, or crazy would this behavior seem to confirm my suspicion?" If the answer is YES or even MAYBE then don't do it!

When a patient suspect they're being unjustly labeled as being a bad patient the instinct is to resist. Patient's get angry or argumentative. They beg and plead. They lose control of their mouths and emotions. They accuse their doctors of incompetence or malpractice. They behave erratically and refuse to work with their doctors. These desperate attempts to resist only confirm the doctors' prejudice toward them.

Instead your strategy must be to come across as calm and above suspicion. Try to act as normal and well-adjusted with your doctor as you do with your friends and family.

If your doc seems frustrated with you say in the most genuine way you can, "I know I'm a difficult case, and I realize I'm in the wrong on this. (Take the blame even if you weren't wrong) I'm still new to needing medical help. How can I do this in a way that help you, doc?"

I realize this feels like giving in to an asshole bully who has mistreated you—and in some ways it is—but if you have an illness that needs medical help and the entire medical system is against you then you might have to play along with our delusion for a while. Sorry!

Knowledge is Power

If you have been unjustly labeled as a bad patient this may be the most important blog post you ever read. Understanding the bizarre psychology of the medical mind is of the utmost importance for you:

• First, you can finally realize it isn't your fault: You really aren't a bad person. It really is a false label that has been attached to you by delusional physicians.

• Second, you can understand WHY the doctor's mind becomes this way: While our prejudice against you is totally indefensible, you may realize that it is a warped product of our desire to do our jobs right and help people. Perhaps this will allow you feel sorry for us instead of angry with us.

• Third, you can make peace with the fact doctors are out of touch with reality: It's hard to take a totally reasonable person calling you bad, but you don't mind if a crazy person calls you names because he doesn't know what he's doing. Don't assume doctors are sane just because we have letters after our names! We are subject to psychological trauma just like anyone else--and we get a lot of it in this job. It is quite possible that you are the most emotionally mature person in your doctor-patient relationship. Treat us like your grandfather with Alzheimers and play along. "Sure Jimmy Carter's the President and the KGB is trying to break into your tool shed each night."

"Don't let the white coat fool you. I'm absolutely bat-shit crazy!"

This knowledge will give you the patience and peace of mind to gradually undo the damage of Bad Patient Syndrome:

Your Long-Term Strategy

If you are stuck as the bad patient no mater where you go then stop switching MDs before you get labeled a "doctor shopper." Pick one doctor and stick with him or her. Pick a doc who seems at least slightly reasonable despite their totally misjudging you. This should usually be a primary care doctor, but if you have a chronic illness you may want a doc who specializes in your condition.

Work patiently with your doctor. Don't try to change you doctor's idea that you are a bad patient anytime soon. Your goal is to let his or her mind change on it's own. Your long-term campaign of patience, kindness, and consistency will eventually wear down your doc's prejudice.

I'm not saying this is easy. Changing anyone's misinterpretation of you is hard, and it's doubly hard when it's your doctor and you feel sick and are worried about your health.

As you work with this one doctor you will learn a lot about doctors in general. We are an odd bunch, but we are also predictable. You'll start to learn how we think: what sets off our prejudices, and also what lowers our defenses and makes us humane.

Chances are if you are getting repeatedly labeled a Bad Patient there is something about your style of interaction that sets off alarms in the medical psyche. Work patiently with one doctor to cure your "Bad Patient Syndrome" and you'll likely find the doctor-handling skills you learned will work with every other MD you encounter.

This Therapy Might Just Save Your MD Too:

Yes, you the "difficult patient" could be the one who saves an MD from becoming and eternal asshole!

Dr. D was once near burn out and lost within the delusion that patients who didn't act the way I thought they should were bad. It only took one patient who I had previously written off as a hopeless bad patient to turn me around. He was so damn genuinely nice to me that I suddenly realized I had been calling one of the most amazing human beings I would ever meet a "hopeless trainwreck."

In many ways a "bad patient" has the opportunity to transform a physician and positively affect thousands of other patients in a way a "good patient" never could.

What do you think?

Have any of you who have been labeled a bad patient every tried this?

Do you think heathcare workers are open-minded enough to reexamine their prejudice about a "bad" patient?

Dr. D always looks forward to reading your stories!

How Could You Think I'm A Bad Patient?

Dr. D recently got an interesting letter from a young woman who got along well with doctors and never had significant health problems …then she got sick. She developed problematic symptoms that required that she seek a lot of medical attention.

What really shocked her, though, was the distinct feeling of hostility she felt from her doctors.

I could totally smother you with this pillow!

Her complaints were suddenly greeted with suspicion. Her report of odd pains resulted in a lecture on drug seeking. She was subtlety accused of being a lying hypochondriac and manipulating the system. When she broke down and cried at this treatment she was diagnosed with "anxiety problems." She had suddenly gone from normal healthy person to the bad patient.

In desperation, she wrote Dr. D to ask, "WTF just happened?"

I wish I could say that situations like this are rare, but they aren't. I've written before about Nice Patient Syndrome. Unfortunately there is also Bad Patient Syndrome, and it claims a lot more victims than the former.

While there some despicable patients out there, many of the victims of Bad Patient Syndrome are really nice folks who are getting the run around. The true illness is a mental one in the mind of medical people:

"The fault dear Brutus, lies not in our patients, but in ourselves!"

Why would doctors label you as being a Bad Patient?

1) We Suspect Everyone

MD's are a naturally suspicious bunch.

"But why would doctors who chose this profession because they want to help people be suspicious?"

Doctors have control over work excuses, narcotic pain medicines, and the exams that determine disability. This makes us popular targets of sleazy folks who want to get things they shouldn't. Docs get told more lies middle school teachers and probation officers. After getting burned a few times we learn to be suspicious. We even find ourselves being suspicious of patients who have nothing to gain from fooling us.

Suspicion becomes a habit of mind. Your docs are like the grizzled old detective walking out of an interrogation muttering, "His story doesn't add up. He's lying!"
Sometimes stories don't add up because people are lying, but sometimes they don't add up because the human body occasionally does strange things.

2) Pattern Recognition

It is often the patients with weird or atypical symptoms that get labeled as the bad ones. Diseases are typically diagnosed by identifying patterns of signs and symptoms. Doctors get pretty good at recognizing common patterns. It gets problematic when your symptoms don't fit any known pattern. We might look up your pattern in the books and run some tests and still come up empty handed. This is frustrating!

Learning the patterns of diseases is very useful. A majority of medical education is dedicated to learning these patterns, but sometimes the doctor's mind begins to slavishly adhere to patterns without exception. We start to think that symptoms that don't fit our patterns aren't "real" problem at all.

If your symptoms don't fit into any known patterns then you must be full of shit!

The human body, of course, is extremely complex and each person's body is unique and acts slightly differently from all others. The number of patients with signs and symptoms that don't fit known patterns shouldn't surprise us at all, but if you bring us a pattern we've never seen before we might just blame you.

3) Impotence

Doctor's hate to feel helpless. Our work gives us an incredible (almost superhuman) power to identify dieases and save lives. Like all superheros we are expected to use our powers for the good of mankind. Our patients expect us to be all-powerful and we like to feel powerful and needed.

Then you come along and we can't help. Heck, we sometimes can't even figure out what's wrong with you! Suddenly we go from feeling like superheros to pathetic loosers. Not only are you kryptonite to our superpowers, but you still expect us save you when we find all of our medical powers useless. We hate feeling this way!

What we should do is admit that we aren't superheroes after all and confess that your situation has confounded our ability to help. From personal experience I can tell you this is really hard to do.

Feeling powerless is a huge narcissistic injury to our superhero ego. It is a lot easier to accuse you of being a villainous bad patient who is unworthy of our heroics, that admit that we aren't as super as we would like to be.

4) Of Maybe You Are Just A Manipulative Asshole?

It does happen sometimes, but I believe many of our bad patients are just getting a bad rap. So if you are one of the unlucky innocent victims of Bad Patient Syndrome I am very sorry. It really does suck!

How do you overcome Bad Patient Syndrome? Well, it isn't easy, but Doctor D has some suggestions coming up in next week's post.

What do you think?

Have you ever been the "bad patient" or been the heathcare provider who misjudged a patient?

Doctor D always loves to hear your stories and opinions in comments.

What Is Nice Patient Syndrome?

A reader writes:

"My doctor says I'm one of the nicest patients he's ever met. He says that really nice people always get the rare incurable diseases. How can that be?"

Oh no! You've got Nice Patient Syndrome! Your prognosis is grim!

There's only one cure: Do something horrible quick! And I'm not talking about saying a dirty word or two. It takes serious antisocial mommas-lock-up-your-babies-cause-there's-a-crazy-person-with-an-axe behavior to save you from the terrible fate of Nice Patient Syndrome!

Why would the nicest human beings end up with the worst diseases?

Ask any doctor, nurse, or therapist... We've all noticed it. The most saintly human beings any of us have met seem to be the ones that get the rare, miserable, and rapidly fatal diseases. We are all astonished at the sheer angelic goodness of these patients, and we tweet message after heartfelt message about how our patients heal our hearts than we could ever heal them.

Ever notice how this shit only happens to the nicest people?

Nice Patient Syndrome really does bring out the best in the assholish medical profession. We give hugs, we fluff pillows, we do bake sales in our spare time. Dr. D once bought a ton of medicines for a nice patient who couldn't afford them. After their untimely demise we go to the funerals of our nice patients and tell their relatives how we never met a better human being.

I'm sad to hear that your doctor thinks you are wonderful, because that means have a really scary disease.

And here's the real kicker: You aren't half as nice as all the doctors and nurses who are fawning over you think. And they aren't crying for you when their eyes well with tears—they're crying for themselves.

Mental Distortion

One thing you have to realize about healthcare workers is that all of us have been traumatized, whether we admit it or not.

Your average graduating medical or nursing student has seen as much death, pain, and misery as a soldier returning from a war. Most of us wouldn't admit that this affects us. In fact, we pride ourselves in not letting it get to us. "I'm a professional dammit, and telling the 3rd person this week that they've only got months to live doesn't keep me from doing my job professionally!"

We usually do a passable job of managing (suppressing) the emotional effects of our jobs. The first few dying or crying patients may have gotten to us, but we don't feel it anymore. We promise! Just another day at the hospital...

Many of the particular quirks of doctors and nurses are psychological defense mechanisms resulting from the mental trauma. Our experiences may turn us into jerks, but we'll turn patients with scary diagnoses into angels—either that or monsters.

Fear of Dying

Doctors and nurses cannot do our work if we're afraid, but it is anxiety-producing stuff we see every day. We are the ones that watch everyone suffer and die. We watch young and healthy people get awful diseases. We see miserable people that we just can't fix. We get the fact that everyone inevitably dies someday (and many deaths are not pretty) shoved in our face daily.

Watching strangers suffer and die actually isn't as hard as you'd think. The real mental anguish comes when we reflect that the same sort of thing will eventually happen to ourselves and the people we love dearly. Dr. D does a good job taking care of sick and dying kids, as long as he doesn't wonder if this might happen to Little D someday.

We need to find some way to think of you as different from us.

If you are totally different from us then whatever awful thing is happening you to won't necessarily happen to us.

I hate to admit it, but first we look for the bad in you. If you've made some shitty decisions in your life or you are rude or manipulative with us then we conclude you deserve it. "This sort of stuff happens to assholes like you—Karma, bitch!"

But if we don't find some reason to hate you we conclude that you must be a saint. You are too good for this wicked world! This burden was laid on you because only a truly superb human being like you could handle it.

"Look, we really need you to do this for us. You don't mind, do you dear?"

We'd rather admit you are better than us than to admit you're just like us.

We feel safe from the fear of ending up in your shoes as long as you are absolutely different from us. "That sort of terrible thing happens to assholes and angels but not normal dudes like me!"

The Complications Of Nice Patient Syndrome

There are plenty of advantages to Nice Patient Syndrome. If you are going to have an awful disease it sometimes isn't so bad to be surrounded by healthcare workers who think that they aren't worthy to be in the same room as you. Trust me, you've got it much better than the ones we conclude are assholes! We'll bend over backwards for you. You can and should milk this!

There are, however, disadvantages to being though of as the nicest patient.

• You aren't a real person to us. Your goodness we keep fawning over is a creation of our own mind.

• We tend to be paternalistic with "Nice Patient Syndrome" patients. We don't want to bother your pretty little head with the dirty details of your disease, so we just make the decisions for you.

• We expect you to handle pain bravely. All that goodness makes you more resistant to pain than mere mortals! We rave about your fortitude in the face of pain, and you want to keep our respect so you won't tell us how much you're hurting.

• When we do treat your pain we will knock your ass out! We adore you so much that if you do mention you're hurting we might Michael Jackson you by accident.

• You actually aren't what we imagine you are. We sometimes send people to meet their maker convinced they have far purer souls than they actually do. You are yourself—the good and the bad. Don't buy into our delusion!

How To Handle Your Sainthood

Rule #1: Don't try and convince us that you are a normal person. Sure, you are just trying to be humble, but insisting you have flaws is actually very threatening to us. If you are just like me then whatever scary thing that is happening to you could just as easily happen to me.

"I think the world of you Mr. Smith. That's how I keep from wetting my pants when I read your chart."

You can't change us. We are damaged goods.

We are frightened by your suffering and Nice Patient Syndrome is a deeply-rooted defense mechanism that isn't going away.

If you try too hard to prove you have faults you might suddenly get labeled the asshole patient that deserves this and can't die soon enough.

Rule #2: Accept your sainthood! Learn use your new-found powers:

• Speak clearly and directly. Your words carry a lot of weight with us, but you have to sometimes speak forcefully to overcome the narrative running in our heads of whatever we expect an angelic person would say.

• Kindly but firmly demand control of your care. This is your disease, your pain, your death! Don't let your doctors and nurses take over just because they adore you.

• Defend your fellow patients. Just like you aren't the angel we think you are, the asshole patients aren't half as bad as we think they are. "Difficult patients" are the victims of the same splitting defense mechanism that created "nice patients" like you. Don't try to convince your MD or RN your fellow patient isn't that bad—it won't work. Just remind us to show more kindness to the assholes. We'll do it if an angelic patient like you asks us.

• Ask for lots of extra ice cream. We'll keep bringing it till you get a stomach ache!

Dr. D loves to read your thoughts in the comments.

A lot of you who read this blog have some really scary diseases:
-Have you ever been on the receiving end of Nice Patient Syndrome?
-How did you handle it?

Healthcare Peeps:
-What is your experience with Nice Patient Syndrome?
-Do you agree with Dr. D's theory of the condition?

Doctor D Crossed The Line!

Doctor D has been blogging about the Doctor-Patient relationship for a while now. It’s sort of the thing I’m known for. I’ve usually been on the doctor side of this equation. Most of my blogging, however, is to help patients figure out the weird world of medicine.

Well, guess what? Doctor D recently found himself on the patient side of a nasty injury!

Even as Doctor D looked down and realized his leg wasn’t supposed to be that shape he said to himself, “Self, take mental notes! The readers of Doctor D’s Clinic of Doctor-Patient Relational Awesomeness will want to know about this."

Here is what Doctor D discovered when he became Patient D:

1) Doctor D Is Mostly Right

Any reader of this knows that Dr. D’s insight is typically brilliant and totally useful. I found myself actually looking up posts I had written for the solid and useful advice.

But even D has a lot to learn, so from here on I shall delve into the dark secrets I could only discover when crossing the line to the patient side!

2) Being The Patient Is The Hardest Job In Medicine

We doctors think we have difficult work. We have to slave our asses off for years in school. We are expected to be perfect and heroic while working with huge uncertainty. We try to protect your health, comfort, and life, while you patients just lay back and get taken care of!

Lying here isn't as relaxing as overworked docs think it is.

Just a few days as a hospital patient cleared my mind of any misconceptions. Abject helplessness combined with severe pain trumps everything. And helplessness is far worse than pain. Dr. D had never done anything as a doctor that caused more stress than allowing myself to be put to sleep for a major operation with a surgeon I had only spoken to for 30 seconds.

3) There Is Much More To Pain Than A Number

Doctor D has written a lot on pain scoring, so I attempted to rate my own pain as a matter of curiosity. I have a good imagination for what 10 out of 10 pain would feel like, so I gave the feeling of multiple shattered bones crunching whenever my leg moved a 7, which made it the most intense pain I’ve ever felt, but I could totally handle the excruciating acute pain.

The real surprise was realizing that duration of pain was far worse than intensity. I had a throbbing pain during my recovery that I could rate as a 4 if I’m generous, but it lasted for weeks and nearly drove me insane. Low-intensity pain that won't leave can make a person much more miserable than 10 out of 10.

4) Narcotics suck

I’ve seen a lot of nice people get addicted to opiate pain medicines. So Doctor D was the dude in the ER with a bone sticking out of his leg begging not to be given morphine. When they finally convinced me to take the narcotics I was please to discover I didn’t get any high. But what I did discover is that they made me miserable in other ways. I was groggy, nauseated, itchy, constipated, and mushy-brained whenever I had to use them.

Their efficacy varies drastically from person to person. I can say with certainty that a 400 mg Ibuprofen was significantly better for pain for me than a 10 mg Percocet, but since my Ortho wouldn’t let me use ibuprofen I was stuck with narcotics. So I then had to deal with the suspicious look when I told the doc I needed more because I had run out.

I am so happy to be off those things! As a physician, it was a bit eye opening to experience how inconsistent and imperfect our best pain medicines are. Managing the pain of a fellow human being is about as frustrating a situation as an MD can experience. I doubt my prescribing patterns will change much, but I do have a deeper appreciation for how hard it is to correctly wield the double-edged sword of pain medicines.

5) Being Disabled Can Really Crush An Ego

Regular visitors to The Clinic of Doctor-Patient Relational Awesomeness are likely aware that Doctor D has a very healthy self-esteem. 3 weeks of lying on my back absolutely helpless and unable to do anything had me at the lowest place I’ve every been. One night I—a generally tough dude—cried myself to sleep. I’m up and moving better now, but I will likely have a limp the rest of my life. My whole life I’ve been able to do everything physical I wanted to do. Now I’m one of the broken people. It’s going to take some getting used to.

I know as physician I often see people with broken and damaged bodies. It kind of annoyed me when people whined about it. “Look, we can’t fix everything, so be a grown up, get over yourself, and quit complaining!” It’s easy to feel this way when you aren’t the one with the disability. I’ve given myself that same pep talk a lot in the last two months—It doesn't work as well when I’m the one with the gimp leg. A lot of my patients have far worse problems than my leg ever was. I’m manning up to fact that my leg’s gonna hurt for decades, but I think I’ll be much more patient towards patients with severe disabilities in the future.

You can't say you wouldn't complain about it if you've never been there—it's a good thing for docs to keep in mind.

6) There Isn’t A "Sort Of Person" These Things Happen To.

Okay, I have to admit something a bit embarrassing here: We doctors sometimes think of our patients as a completely alien form of human life. It isn’t intentional. We wouldn’t even admit it out loud. It’s a weird psychological quirk that happens like a reflex.

Doctor’s see so much suffering and misery on a daily basis, and we just can’t spend all our time worrying if it will happen to us too. So we develop this mental trick: "These things won’t happen to me, because I’m not that sort of person." What sort of person? Well, the sort of person who ends up the patient with a painful or horrible condition, of course!

Unfortunately, psychological defense mechanisms are useless when the cold, harsh laws of physics apply pressure to human bones. This shit happens to everybody—even doctors. No one is the sort of person that has a debilitating injury, until it happens.

7) Some Doctors Just Can’t Be Helped

Doctor D has spent a lot of time educating you on how to deal with difficult doctors. One of the worse maladies plaguing the medical field is piss-poor communication, and Dr. D’s orthopedist has about the communication skills of a mentally-retarded clam.

There's a lot that patients can do to improve their communication with difficult doctors. I had a lot of questions, and I found myself going and reading my own posts for advice on how to get answers out of a doc with weak bedside manner.

In the end I just gave up. This dude just couldn’t communicate like a normal human being with a patient (even a patient who had an MD). I hear he’s an excellent surgeon and the fact that my leg got put back together is proof of this, but his ability to converse was just dismal.

"I'm sorry, but I don't consider speaking with you to be part of my job description."

When faced with a doctor who simply will not or cannot communicate a patient has two options: Leave or trust blindly.

Dr. D had a FUBAR leg, there was only one Orthopedist available at 1:00 am, and the ER doc said this dude was a good surgeon. So I trusted him even though he seemed mentally incapable of explaining the operation he was going to do. The gamble paid off and the leg is improving, but generally I would have to advise that you hit the road when paired with doctors incapable of communicating—especially if your doctor will need to manage your problem longer than a 2 hour surgery.

Okay, that’s my story and I’m sticking to it!

Doctor D is back to limping around the exam room with patients, and so Doctor D’s Internet Clinic of Doctor-Patient Relational Awesomeness is back too. Send in those questions and I shall keep dropping knowledge on you!

What do you think?

Any of you medical folks have similar experiences and want to add some points?

Any of you with more experience as patients wish Dr. D had picked up more from his time on your side? If so, what did I miss?

Doctor D always loves to hear your thoughts in the comments!

Why Do Doctors Dodge Your Questions?

Part II of How To Get A Straight Answer From A Doctor

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!

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?