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.

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:

Rodeo Bull See-Saw Stunt - Click here for this week’s top video clips

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

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!

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?”

or

“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.

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!

How To Get A Straight Answer From A Doctor

(Part III of Straight Answers From Doctors)

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?

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!