Saved With A Dodge

Part 4 of Straight Answers From Doctors

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!

The Doctors In The Ivory Tower

After spending the last month on sex, drugs, and rock-n-roll Doctor D is back to discussing hardcore medical issues:

Sick Momma asks,

"Everyone tells me I should go to Mayo Clinic or Johns Hopkins. Are the doctors there so much better?"

If you travel to Hopkins or Mayo you are basically paying extra for "name brand" medical care.

Is the name brand better than the regular stuff? Sometimes, but often it's just more costly for the exact same thing. The docs in those places have all published a lot of studies or are recognized names in their field.

"I am the chairman of Medical Expertology at Ivory Tower University, and I am never wrong about anything."

The Academic Brand

Doctor D's time in the ivory tower of medical training revealed to him that the biggest brains in medicine aren't always the best at caring for patients.

Some super-experts will be good at the bedside, but quite a few of them suck at actual doctoring.

Occasionally the super sub-sub specialist expert will know something useful to you that your regular working doc didn't know, but this is more rare than you think. Academic abstraction can also prove a distraction from the simple problem-solving that is often needed. If your car isn't acting right a regular mechanic is usually a better choice than the mechanical engineer at a big name university.

The SuperClinics

The Mayo Clinic is a bit different from academia. They are more hands-on than academic. Superclinics like Mayo pride themselves on being a Mecca for VIP patients.

From anecdotal stories from patients I know who went to Mayo my impression is that they do a lot more tests than most doctors. More tests can be a double edged sword. If you've been reading AskAnMD you know that more care isn't always better. Doctor D has a relative who had a very bad outcome at Mayo after what sounds to have been excessive, unnecessary testing.

In the end, big brand name hospitals and clinics will often do the same tests or treatments your local doctor would do, but the diagnosis or cure is considered more "brilliant" or "amazing" just because it happened Mayo or Hopkins.

A lot of people go thousands of miles to get the exact same care they could have gotten down the street.

Generally speaking I would advise people to work with local resources first.

Only if you are told by the you local docs that you are beyond their abilities would I suggest you look into the big names. Often the primary doctors and specialists in your own area are more convenient and just as good for your needs.

What do you think? Do any readers have first-hand stories from the "Ivory Towers" of medicine? Did you go for a rare disease or a common problem?

Do you think that the care there was superior to the care you could have gotten in your own city?