The Skill Doctors Need To Have, But Haven’t Been Taught

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  1. In Love With Medicine

    In Love With Medicine Golden Member

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    Physicians handle thousands of questions annually. We respond to inquiries from patients, their families, insurance companies, nurses, professional colleagues, pharmacies, pharmaceutical representatives, our staff, and even strangers. This is, of course, a part of our job, and it consumes a substantial amount of our time and energy.

    And, responding to questions is not as easy as you may think. Words matter, and a clumsy choice or omission can wound instead of heal. Here are some of the challenges we face when a medical inquiry is directed toward us.

    We may not know the answer.

    We may misunderstand the question and offer an inaccurate response.

    We may have incomplete data and need to calibrate our response accordingly.

    We may not be aware of the questioner’s true intent and anxiety. For example, the question may seem innocent, e.g., “Is it normal to have constipation sometimes?” when the unspoken concern is fear of cancer.

    We may not have permission from the actual patient to divulge protected patient information. This may be difficult for a close relative to accept.

    We may be reluctant to contradict a colleague to an inquiring patient without first discussing the case with the other physician. If a patient is scheduled for surgery in a week, and we’re asked our opinion, do we express doubts when the surgeon who may know the case better has discussed risks and alternative treatments with the patient in detail?

    We may have the challenge of confronting questions laced with anger. “Why did you send my mom home from the hospital too soon?” “Did you know that medication costs $400?” “Why didn’t you order the CT scan sooner?”

    We may have to re-frame the question. If a patient is being admitted to the hospital from the emergency room with a heart attack, and we are asked by a family member when discharge is anticipated, we are more likely to discuss the impending medical plan than to offer a timetable.
    Some questions either can’t be confidently or comfortably answered. “Hey, doc, how long do I got?”

    “What would you do, doctor, if you were me?” This is always tough. I personally never offer a responsive answer. We are not you and should never pretend to understand your personal universe – your priorities, life experience, risk tolerance, job issues, family dynamics, financial security, cultural influences, religious tenets, and personality style. It’s your call.

    I think these skills are essential to good doctoring. I do my best to handle these challenges decently.

    How much training in medical school, residency, and fellowship do you think I received on this skill?

    Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.

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