• Quick note - the problem with Youtube videos not embedding on the forum appears to have been fixed, thanks to ZiprHead. If you do still see problems let me know.

What do people expect from their physicians?

Dr. Imago

Master Poster
D
Joined
Aug 6, 2001
Messages
2,620
Okay, I'm well into my third year of medical school. I've learned a lot. I've learned to casually put my index finger in places I never thought it would go, for example. :D

But, mostly what I've learned is that doctors don't have all the answers. This has been most evident with a couple "family issues" lately.

First issue: My sister has been having some problems with one of her feet. She saw several specialists and they did bone scans (etc.) and determined that nothing serious was going on, that she needed to stop doing exercises in the gym that were aggravating her foot (namely high impact treadmill running), and that they didn't have a 'definitive diagnosis' of what the problem was. She was upset. "Why don't they know what's wrong with my foot?" she asked me.

Second issue: My grandfather's girlfriend (hey, Ed bless Viagra, Cialis, and Levitra) has been having some swelling in her legs. Again, they do the 'million-dollar work-up' and determine that its not thrombophlebitis, DVT, cardiac, liver disease, or anything else serious. The doctor tells her, "It's probably decreased venous function that happens as you age, but I'm not certain of that. Whatever it is, it's likely benign." She hit the roof! She screamed at the guy, "You put me through all of those tests and you don't know what's wrong with me!??!??!"

In medicine, we work on figuring out what the major red flags are. We try to "rule-out" the bad stuff. Sometimes it takes a while and a long interaction with the patient to develop the correct diagnosis. My question is: Why don't people understand this? Is it because we are doing a not good enough job of explaining the process to them? Do they expect too much from us?

Please. Cast some insight for me. Help me become a better doctor. I'm starting to forget what it was like to be a regular healthcare consumer because, like Dorothy in the Wizard of Oz, I've pulled back the curtain and can see the "wizard" standing behind it.

-TT
 
I would say your examples are bad explanations on the doctors' part. Doctors sometimes need to remind patients that they don't have all the answers.

I expect my doctors to:

Be human. Explain themselves in English, not Doctor. I expect them to make mistakes occasionally, but when they do, own up to them. My mom's doc recently told her that the rash on her scalp and the pain she was experiencing with it was an allergy. Guess what? It was shingles!! Did he apologize for the first misdiagnosis. No. The more docs act like they are all knowing, the more patients will expect them to really be all knowing.
 
I expect an educated opinion, and a remedy if possible, from someone who knows way more about my health than I do.

Nothing more, nothing less.

PS: Don't be such a stranger on the boards!! It's odd that you faded away about the same time Bigfig did. Did you two lovebirds get hitched? :p
 
It's sad but people do expect doctors to be all knowing. They want garauntees and cures; it's probably one reason people go to so-called alternative medicines, because even though the CAM people lie, they offer a feel-good plan.

I'd say Lisa has some good advice; human, upfront, and honest. There are no gaurantees in life, and medicine is not exempt.

I want my doctors to do the best they can, and if they have to get up and look up the answer (which they do), that's fine too, IMO.
 
Lisa Simpson said:
My mom's doc recently told her that the rash on her scalp and the pain she was experiencing with it was an allergy. Guess what? It was shingles!! Did he apologize for the first misdiagnosis. No. The more docs act like they are all knowing, the more patients will expect them to really be all knowing.
Click to expand...

Youch! You're right. And, you've got to be careful with shingles in the head region. There's a syndrome called Ramsay-Hunt that involves the facial nerve (CN VII), when infected, and it can be very painful. David Letterman suffered from a bout of this. Sounds like your mom's was a spinal root, probably C-2 or C-3, and her doc should've known better, or at least apologized. Of course, with the ever-present threat of litigation, some docs are very unwilling to ever admit they're wrong when it happens.

-TT
 
Read Michael Crichton's "Travels," but omit the new-age bullplop that crops up with annoying frequency in the last three-quarters of the book. Read the chapters about medical school instead.

There are some good lessons in there about how to be a good doctor and how not to be a poor doctor.

Crichton also gives away some of the 'tricks" used by medical school students during their rotations.

My brother (now a board certified otolaryngologist) told me quite a few tales of his medical school adventures. And for a couple of years I boarded with a medical fraternity, and the students shared medical school stories after dinner (to my amazement, after a week I was able to eat my meals without being grossed out by the gruesomeness of the conversation). They all agreed that ruling out the really bad stuff is most important, and they also agreed that not all cases are classic cases. Diagnosis is tough, and there is a tendency to agree with a diagnosis previously made, even if it is incorrect.

Perhaps my biggest gripe with the medical profession was its "shoot from the hip" attitude that led to several years of unnecessary suffering.

In particular, I saw several doctors that insisted that I be treated "conservatively" with medicines for cluster headache that first appeared in college. The first medicine made me so groggy that I nearly flunked out of school. And it didn't help relieve the pain. The second medicine made me tired. And it didn't help relieve the pain. The third medicine was the worst of all: it was outrageously expensive, made me so groggy that I couldn't drive, made me tired, made my kidneys hurt, and turned my skin a shade of green that caused my co-workers to think I was dying. And these pills didn't relieve the pain, either. So I was fatigued, groggy, green-colored, unable to work or drive... and I had the excruciating headaches all the same.

And that was when I decided to do my own research. And what I found was that many cluster headache patients had reported complete relief by inhaling pure oxygen. So, when I went to my doctor again, I came armed with books and articles to show him that pills didn't help (which I already knew from experience) but that oxygen might help. The doctor still wanted to prescribe medications, but I got to the point where I told him what I wanted him to prescribe. (Medical grade oxygen is available only by prescription.) He referred me to a neurologist, and she prescribed the oxygen. I had to wade through a bunch of red tape to get some medical grade oxygen, but by golly, it worked!! It relieved the pain, one hundred percent. And it had NO adverse side-effects!

Now, I didn't have to do too much research to find that oxygen worked and that pills didn't work. But dammit, I still feel that the doctor should have done some of that research, and should have at least prescribed oxygen on a trial basis. I went through several years of agony--for nothing, it turns out.

If you go to an architect or a lawyer, for example, and they don't know the answer to your question, then they say they will research it and get back to you. Sometimes I wish that is what the doctor would say. Doctors don't need to know everything off the tops of their heads. That causes too much shooting from the hip.
 
I want clear information provided in a straight-forward manner. I also preferr a businesslike approach. I've been dealing with a lot of doctors lately in dealing with throat cancer. Out of the three I'm seeing regularly, I preferr the ENT that actually hacked the tumor out of the back of my throat. He's a hands-on guy, very practical, and gives straight answers. It's sort of like one mechanic talking to another.

The one I like the least is the radiological oncologist, but that might be because of a bad initial meeting. He's a nice enough guy, and does his job well. Then again, there's that queen b!tch of a nurse he has who prepped me for a procedure without checking to see if it was necessary (which it wasn't, and that's why she doesn't get to do anything more than take blood pressure and weight when I go back in). I think I dislike dealing with her, which poisons the relationship I have with the doctor.

You've gone in for one tough line of work. I have enough trouble dealing with the brand of watches I repair -- EVERY one of them I see is broken or not working correctly. The logical part of me knows that it's because I'm a watchmaker, and no one sends their watch to us because it's working splendidly. I only see the malfunctioning ones. About every six months or so, I have to make a field trip to one of the boutiques and spend some time appreciating the stock in its pristine, perfect condition to sort of recharge my spirits. You might want to make time to interface with reasonably well people every once in a while.

Regards;
Beanbag
 
Third Twin,

I think you're right: the fear of litigation is a part of the problem. I don't blame MD's for not admitting to a mistake, for that reason. Perhaps what they could do is to explain how they came to the original diagnosis, and what new information (test results, lack of response to the treatment, etc.) led to the correct diagnosis. This may help people understand the process and why diagnoses aren't always correct the first time.

I'm not a doctor, but I play one on television. Just kidding. :D

Actually, I run into similar problems in dealing with people who are concerned about chemicals and environmental health issues. For example, someone may complain of "a smell." Then they have an expectation that it's simple to take a sample and determine what "the smell" is. I do my best to explain that one cannot just run a test and figure out what something is, and why. Then I explain how we will investigate to try to determine where "the smell" is coming from and what it might be based on people's experience of it, timing, any noted health symptoms, etc. If this gives us enough info, then we can determine what type of test(s) to run. I keep them informed as the investigation continues, and then have a discussion with them regarding the results. This works well with most people since it helps them understand and they don't feel talked down to.

But there will always be people who refuse to accept anything that is explained to them. When you run into those folks, just do your best to deal with them, know that you did your best, and then don't dwell on it.

We need good doctors such as yourself. Best to you in your career. :)
 
For me, as a pharmacist, the majority of patients are idiots. You simply can't explain to them that something won't work or have the results they expect. They will trust an advertisement on TV more than an expert. They will trust a self-proclaimed expert more than a real expert. People like windbags.

A new physician in my area started with the best of intentions. He wouldn't give any serious drugs for a simple cold, he wouldn't even take money. But the patients were not happy. They kept going to other MDs who prescribed antibiotics to everyone. The patients were feeling better when taking pills. The other doctors were treated better by the pharmaceutical companies. After a couple of years the new physician changed sides. He now prescribes like crazy. There are also similar but more horrific stories about unnecessary operations, etc.

People want answers and easy solutions. People don't want to hear you say "I don't know", especially when there are other physicians around who will not say the same. Don't judge the average person from this board of skeptics.
 
ThirdTwin said:
Please. Cast some insight for me. Help me become a better doctor. I'm starting to forget what it was like to be a regular healthcare consumer because, like Dorothy in the Wizard of Oz, I've pulled back the curtain and can see the "wizard" standing behind it.
Click to expand...

You're asking a group of people who are smarter than the average bear, so you might get some skewed results. I'm trying hard to present results that aren't so skewed:

1) Purchase a copy of the original M*A*S*H movie (better than the book) and a copy of House of God. Memorize both. If you ever find yourself thinking or acting like any of the characters, strike yourself sharply in the head with a meat cleaver.

2) Listen to the best of the nurses. They have more practical knowledge than you do and always will.

3) Don't provide facile diagnoses that do nothing more than rename symptoms. If someone has inflamed skin, don't declare ex oficio that it's dermatitis as if that actually meant something.

4) Don't write prescriptions for antibiotics when people don't need them.

5) Remember that most patients had to wait several days to get an appointment. Some may have felt they had to save up money first. So don't tsk tsk them for letting the problem go.

6) For every minute that you spend with suited schmucks who come to your office trying to sell you stuff and giving you free samples, spend five minutes reading journals.

7) Contribute to journals as well. Try to publish one paper a year. At the very least, get one rejection slip a year.

8) Remember that most of the people who come to see you have worked as hard as you have every day of their adult lives.
 
Brown said:
If you go to an architect or a lawyer, for example, and they don't know the answer to your question, then they say they will research it and get back to you.
Click to expand...
Er, yes and no. In my experience they get a junior to do the research and charge you $250 an hour for the education they are getting. Perhaps that's just my experience. ;)
 
Lisa Simpson said:
I would say your examples are bad explanations on the doctors' part. Doctors sometimes need to remind patients that they don't have all the answers.

I expect my doctors to:

Be human. Explain themselves in English, not Doctor. I expect them to make mistakes occasionally, but when they do, own up to them. My mom's doc recently told her that the rash on her scalp and the pain she was experiencing with it was an allergy. Guess what? It was shingles!! Did he apologize for the first misdiagnosis. No. The more docs act like they are all knowing, the more patients will expect them to really be all knowing.
Click to expand...

Hey Lisa Simpson, how did your mom finally get the correct diagnosis?

Was it a second opinion? Sometimes I just don't know where to get one. Most doctors around here don't see "new patients". I can go to my doctor, and then a walk in clinic. Is that a good idea though?

Okay, an experience I am going through right now. I have these muscle twitches. I get told it is PROBABLY due to stress. That's fine, but how does stress make your muscles twitch? Tell me that, and I'm not wondering how that is possible. I'm frustrated because he also tells me there is not much I can do to make them go away, so just do my usual things to help me deal with stress, and add on some calcium (that makes me constipated). So how does calcium help, and muscle relaxants won't? He also tells me there is no way to know if or when they will stop. Why? I just get the stock answers that I just need to give it some time.

He did graciously send a letter to a neurologist. I get a call that I can come see the neurologist in October of 2004. &$*#$#@ The one person that might be able to answer my questions is practically unavailabe. 8 MONTHS to see him!?? Not only that, but people tell me that the neurologist in town here is mean and will make you feel like you are wasting his time and that the problem is all in your head. Being that it may be stress, yeah it may all just be in my head...but how does that get my muscles twitching so much that it wakes me up at night?

Doctors hesitate to tell you why something could happen. Is it because they think we won't understand? I have taken some biology, and even anatomy. I just might understand. So I look up stuff on the internet. Ouch. Talk about quack city. There are tons of sites to sell you sCAM stuff that promises to make you all better with no side effects. It's tough wading through all the misinformation.

Can't doctors tell patients why antibiotics won't help them in a way that they will understand? Does there need to be a booklet on viruses on hand that doctors can give out? Maybe about viruses, bacteria, and antibiotics-and dangers of overusing antibiotics? I think patients will listen if they know that the next time they do need antibiotics they might have to take stronger and more expensive ones if they use them when they aren't necessary or don't follow the directions when they are necessary.

I listen to my doctor when they say antibiotics aren't necessary. I know viruses cannot be affected by them at all. There are times when a secondary bacterial infection needs antibiotics though, but I understand it is for the bacteria that are taking advantage of the fact that I'm being attacked by a virus (in the simplest of terms).

When asking what to do when sick because of a viral infection if they can't have a pill to take, what will be done? Is there an explanation on why drinking fluids will help, and what kind of fluids to drink to prevent electrolyte imbalances that will cause painful gas? Is there a list of what not to do? My son's grandma tried to tell me to give my son cheese when he has diarrhea. I knew that was a bad idea, but I didn't really know why, and couldn't tell her.

Treating people like they are smart enough to learn a few things to take care of themselves helps. That's why sCAM treatments come with bogus, but easy to understand explanations of how and why their treatments work. People then feel they are doing the right thing because they know how and why it works (supposedly).

This is not something they get from their doctor. They get a mysterious drug from the doctor with no explanation on what it will do and why it will do that. Then they experience scary and uncomfortable side effects. I had a side effect once that wasn't listed as a side effect, and so of course the doctor never mentioned it. I was freaked out thinking I was pregnant - the meds made me lactate because it did something to my oxytocin levels. Did the doctor let me know the drug might mess with my hormones? No. I was embarrassed when I found out I had freaked out about something that wasn't even happening.

What do I want from my doctor? Reasonable explanations about my problem and why it is happening, and about the medicine he will be prescribing and why it may help. Then I can work with him if it doesn't seem to be helping and giving me crazy side effects (instead of me misdiagnosing my own situation). I went on a similar medication that helped me better without making me lactate. I'm lucky I got to see him right away before stopping my birth control-since I don't think it is a good idea to be on the pill when pregnant.

Okay, so my long winded attempt to explain what I need from my doc. Information mostly. Why is this happening to me...or morely how. If you can't tell me, please direct me to a source I can access information from. Tell me other things my medication may do even if you don't know exactly how it will affect me (this med can cause side effects due to hormonal fluctuations).

If I can figure out why stress makes my muscles twitch, then I'll know if I need more sleep or more exercise. Right now I don't have a clue.
 
TT,

As a consumer and as Paramedic, here is what I have learned.


Most people are stupid, but you can't treat them that way. If they ask questions give them the real deal. If they sit there, nod and give you a blank look, use plain english and expect them to understand less than half of what you say.

Media today has given the impression to the general public that Dr's know everything and have available to them the latest technology, regardless of where you are. I have found that the best answer is often "I don't know. I wish that I could give you more information, but sometimes there is no answer." They may accept it, but will appreciate the honesty.

Read and then read some more. I am required to attend a week long update course every year. I still spend hours each week devouring journals. My patients expect me to know and understand their treatments and conditions, many of which are chronic and have nothing to do with why they called 911 in the first place.

Patients are stressed by the time you see them. Starting with pre-auth, paperwork, insurance (if they have any at all), how they will pay the bill, taking time off from work, family concerns and every horror story they ever heard, read or saw about symptoms just like the ones they have. Most people want a perscription and reassurance.

Many patients are looking for validation ( I hate that word) that there is something wrong.

Finally, remember the stages of grieving. Even if the patient is not terminal they may still react with anger, denial, bargaining before accepting. Particularly if it is a chronic condition and a normal part of aging.

Hope this helped.

Oh and that bit about listening to the nurses... goes for tech's too. They are specialists in their own right. Don't forget to say 'Please' and 'Thank you', it will go along way and is remebered long after any flowers, cookies, or other little tokens are gone. Trust me.


Boo
 
Are you asking about what we expect from our physicians, or what we want from our physicians?

I expect my doctors to be patronizing, unwilling to admit error or ignorance, and unable to consider generally accepted treatment methods with a critical eye, if they can be persuaded to discuss them at all.

What I want is rather different.
 
A lot of you have mentioned medical mistakes, but Twin's original post focused more on not knowing how to help someone rather than making outright mistakes.

I agree with the poster above that docs should do a better job of researching patients troubles after the visit, if necessary. Even within a given specialty, its unreasonable to expect (or for doctors to presume) that they are capable of sifting thru the vast amount of pathophysiology and pharmacology in a 10 minute patient visit.

Part of the problem is just the complex nature of human medicine. Some people view docs as glorified car mechanics. Unlike a car mechanic, we cant strip you down to your "nuts and bolts" to really see whats going on at the root level in many cases. Sure we have blood tests and fancy imaging methods, but those are a far cry from a mechanic's torque wrench and hydraulic lift in their comparable ability to "see" problems.

All together, I'd rather patients expect too much rather than too little. It pushes us to work harder and be better. I think people can and should expect/want more of their doctor that they would not expect of their lawyer, accountant, etc.
 
Ok many people here address some relevant facts about medical care ( probably in a hospital setting ) that are wanting. I have been subject to assembly line medicine. That said, I think that most patients are completely ignorant of THEIR responsibility for their own care.
The maintenance of one's body is a two sided affair it is neither the sole responsibility of the Physician nor is there a pill, shortcut, quick fix for chronic disease.
Your responsibility is to educate yourself and engage, be involved with your health and any remedy that is prescribed to help you or your condition.

There are for sure uncaring doctors , but if you educate yourself you will only help yourself and the attending physician.

BTW Third Twin where ya been? Internship....48 Hr days? Stick to it man =)
 
One more thing:

9) If it's going to hurt, don't tell me that it may feel a bit uncomfortable. If it's going to stink to high heaven, don't tell me it "has a characteristic smell."
 
ThirdTwin said:
Youch! You're right. And, you've got to be careful with shingles in the head region. There's a syndrome called Ramsay-Hunt that involves the facial nerve (CN VII), when infected, and it can be very painful. David Letterman suffered from a bout of this.
Click to expand...

Are you sure? My understanding of the reason for his long absence, admittedly from the popular press, was that he had an outbreak under his eyelid, which is dangerous as well as painful. This could be related to shingles, I suppose, but it could also be related to one of the other herpes viruses.
 
Originally posted by TillEulenspiegel
Ok many people here address some relevant facts about medical care ( probably in a hospital setting ) that are wanting. I have been subject to assembly line medicine. That said, I think that most patients are completely ignorant of THEIR responsibility for their own care.
Click to expand...

This is only peripherally related to your posting, but it reminded me of something.

As for assembly line medicine, that's one aspect about medicine that I don't dislike. I don't mind being treated like a piece of meat, and I don't want my "whole person" treated. I'm responsible for that, thank you very much.
 
You must log in or register to reply here.

Back
Top Bottom