Can a doctor dodging a question help the patient?

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 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.

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 an 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.

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.”

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

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  • Doug Hall

    These types of statements kill.

    “Chill out, Your kid is doing fine. He’ll be okay.” and “Sometimes patients don’t need factual answers.” and “This brilliant Expertologist totally dodged even trying to answer my question and told me what I needed to hear, “You kid is okay.””

    • http://thedocsquawk.com thedocsquawk

      Maybe, but he’s still right. Most of the time reassurance is all patients need.

      • http://www.twitter.com/alicearobertson Alice

        Reassurance and facts are the doctor’s job. Ignorance can kill someone. Sometimes residents or the patient can pick up on the doctor’s slack. It is not up to a doctor to decide this. Their job is all the facts, but sometimes it makes their job easier to become the author of your emotions and convince themselves they saved you heartbreak. Withholding info just isn’t what we pay for. No matter how sincere or compassionate it seems…..we can try to justify it….make it seem as if we appreciate it……but that seems to work for doctors who like to understand their colleagues objective. It just doesn’t do it for me. I’ll take the pain and do my own research…..just tell me the facts and what options you feel I have…..then I’ll pick up from there and deal with my own emotions. In other words……I don’t want protected from myself……that’s not what I pay for.

  • http://abnormalfacies.wordpress.com/ Jim

    I agree, Doug. I’m a student and was just recently in a mock exercise with a standardized patient wherein another student dodged delivering a prognosis for GBM.

    The physician overseeing the exercise said “The patient doesn’t need to know that much right now” – I completely understand not dropping a bomb on someone in what will be the first of multiple visits, but when a patient has to ask 3+ times to figure out what you already know (that their condition is terminal), that’s wrong.

    Old-school, paternalistic medicine is out, informed consent and Google are in (I thought to myself: what if I sent this patient home and she looked up the diagnosis – I’d probably have an ireful message waiting for me the next morning). Leaving out a crucial piece of information, even if you’re “saving it” for a later visit is a great way to lose trust and has the potential to damage one’s career, IMHO.

    (NB: I don’t wish to criticize this student, but rather the physician who approved of this. The point of the exercise was to help us navigate difficult encounters)

  • http://Www.twitter.com/alicearobertson Alice

    Hmmmm…..I have sat where you have…I tend to think doctors either do not have the answers (the really smart, honest ones know how to say, “I don’t know” the others don’t) or they placate. There is no perfect presentation to a desperate parent…I know you know this. We were nearly placated into a much worse situation, so for me it wasn’t a good answer to promise a type of rosy future. I think it is very difficult for a doctor to look a parent in the eye and give them bad news. I am thankful our surgeon tells me everything. I once asked him if he hates his job on those days…he softly replied that he would not want to be sitting where I was. I considered it a kindness that he told me everything.

    If Doctor D is reading this I wondered if his child’s illness was a catalyst to better things? Empathy? Research? As painful as it is to go through these experiences it seems to enlarge our hearts. There are organizations formed, research dollars created from the vision and passion our heartaches create. The outcomes often benefit so many people that it makes the journey worthwhile.

  • Jeanja

    There are two kinds of non-answers: those that pretend to be answers (e.g. “Your diagnosis could be a number of things” when you actually have settled on GBM) and those that are obviously non-answers (e.g. “Oh, I think he’ll grow up and play sports.”). If it’s obviously a non-answer, the patient KNOWS they can push for a real answer. In fact, it crossed Doctor D’s mind to do so– he thought about saying, “You didn’t answer my specific question!” The fact that he did not follow through suggests that subconsciously, he accepted the reassurance. And on the drive home, his conscious mind accepted it, too.

    I’m comfortable with obvious non-answers, like what Dr. D got. The non-answers disguised as answers are a tougher call.

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