Why good doctors give useless answers

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.”

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 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.

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.

Doctor D is a physician who blogs at Ask An MD.

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  • MsJulie

    This is wonderfully insightful! And it doesn’t just apply to doctors.
    However, it’s easy to see where an image problem arises.
    Thank you for posting.

  • http://www.notimetoteach.com Fran London

    Very interesting. One way to avoid giving useless answers: ask the patient, “Why do you ask?” Then you could tailor your answer to match the needs of the learner. Does the patient not understand, and just needs a basic explanation? Does the patient need referral to websites to learn more details? Does the patient just need reassurance? A little assessment can save a lot of teaching time.

  • Davis Liu, MD

    Good doctors don’t give useless answers.
    Doctors who think they are good doctors do.
    Good doctors tailor their responses depending on the individual patient’s needs, desires, and interest.
    No wonder there is an empowered patient movement. If I got answers like these I would be equally as outraged.

  • Greg

    My business consultant colleagues report having seen this same phenomenon from a different angle. Over drinks they talk about how the questions they get from clients often fit exactly into the above categories. They talk about how otherwise collegial professional relationships go sour because the client asks questions that are irrelevant to the task at hand and require significant explanation, at the expense of time spent doing something actually productive. Unlike doctors, however, consultants bill by the hour, so they still make money even if the conversation is a waste of their and the client’s time.

    Maybe paying primary care doctors by the hour can help decrease both patient and physician frustration at this problem?

  • drjebj

    Excellent article. I would like to see this insightful piece get wider distribution among the public.

  • stargirl65

    So I can avoid answering questions because your insurance company doesn’t pay me to do so? I doubt my patients would like that answer. But unfortunately it is partially true. We are not paid for talking to patients. (With the exception of psychiatry but those payments are often not great.)

    • gzuckier

      Which in turn drives the current trend towards patient empowerment, with insurance companies vying to provide their members with the most informative websites offering the most up to date and complete information; which in turn can cut costs, if patients can find out what they were wonanswer their questions without a visit to their PCP.

  • BladeDoc

    You value what you pay for, you’ll pay for what you value. When medicine went with the ICD/CPT model the death of communication should have been predictable.

    That being said, I find that in the ICU #2 and #3 are the biggies.

  • Kevin N.

    Great topic. Insightful commentary.
    I think, as docs, we’re often in a lose-lose here.
    Unless you can target exactly in on your patient’s IQ and educational level, it’s almost impossible to hit this target. We’re bound to talk over peoples’ heads, and condescend, without ever meaning to do either. Of course, if time were unlimited (ha!), it’d be easier to understand what our patients want to know, why they want to know it, what they’re capable of comprehending, and then delivering info perfectly.

    • gzuckier

      Absolutely; good doctors get to know their patients and tailor the interaction to the appropriate level. I’m looking for very different information than my parents are, for example.

  • http://www.notimetoteach.com Fran London

    Kevin, I agree we can’t always hit the target, but I suspect we can get a lot closer in the limited time you have with honed listening skills.

    Have you seen this article?
    Langewitz, W., M. Denz, et al. (2002). “Spontaneous talking time at start of consultation in outpatients clinic: cohort study.” BMJ 325: 682-683.
    It says, “Most patients finish talking about their medical complaints within 2 minutes if allowed to talk spontaneously and that the information provided during this time is useful.” If we can really listen in those 2 minutes to the words the patient chooses, the depth of understanding revealed, and the degree of concern, I believe we could better tailor our responses to effectively communicate and clearly answer their questions.

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