I ran into a new blogger, one Dr. D, via KevinMD, who raises some intriguing points in his four part series about doctors answering patients’ questions. Dr. D’s series is ostensibly directed at patients whose doctors dodge their questions or give them vague answers. Here are some of the reasons he gives why this happens:
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.”
While I agree with all of these, I think Dr. D is missing the point a bit.
I think the art of answering questions lies in figuring out what it is the patients really wants to know, and telling them. Before you all go jumping down my thoat about my nasty paternalism (“I know what questions I want to ask! How dare you go assuming you know ‘what I really want to know;!”) allow me to point out that even Dr. D concedes this point, when he describes an Expertologist (great term; I may have to steal it make sure it gets greater exposure) supposedly ducking the question he actually asked to provide him with what he really needed to hear:
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.
There are many reasons why patients ask the wrong questions – and by “wrong questions” I mean questions that even if fully and accurately answered will not provide the information the patient really wants, even though he doesn’t realize it. The patient often doesn’t have the background knowledge to determine the best way to elicit the information he is seeking. Patients often underestimate the complexity of the mental processes we bring to bear on their diagnosis and treatment, and can’t understand why the doctor can’t answer what appears to them to be a straightforward inquiry.
Then again, doctors sometimes answer the wrong question. Stomatitis is a nasty, painful chemotherapy complication of methotrexate. If you respond to a patient’s question, “How do you treat stomatitis?” by saying, “Folic acid,” the question you have actually anaswered is, “How do you block the effects of methotrexate?”The correct answer about stomatitis treatment is, “Supportive care to let the mouth heal on its own, while blocking further effects of the methotrexate with folic acid.” (If you really want to be an arrogant prick, respond to the patient’s legitimate follow-up question, “What’s folic acid?” by holding up your hand, replying, “I don’t have time to discuss vitamins with you,” and sweeping out of the room with your retinue of residents and students.)
There is indeed an art to combining an answer to the question the patient asked, while explaining why the answer to a better question will be more helpful. I find it best to do this explicitly, so as not to get caught up in the form, rather than the substance of the interview (“She never answered my question,” even though I did actually provide the desired information). I’ll say, “The answer to your question is XYZ, but you also have to realize that ABC.”
Truly the art of medicine is the art of answering questions.