Thursday, June 11, 2009

I usually have no qualms on sharing with patients how little I know.
"I dunno..." is something I say pretty readily.
But a couple of days ago, I had a patient tell me he appreciated me for it. The scenario is fairly similar- some physician refers his patients to me for 'fatigue/dry hair/weight gain/lack of interest/hair loss' just because it has to be related to the hormones.
Often, it's a last ditch effort in that the other doctor hasn't been able to explain things. Sometimes, it's just a convenient punt: The endocrinologist will make all your problems go away.
And so, patients come with misaligned expectations, ones I am not able to live up to. And so I've learnt to make it clear- in the appropriate situations I'll screen them for any endocrine disorders. But if things come back normal, I'll have to gently tell them that while modern medicine has advanced far, there are, and will always be, things we cannot fully explain about the body.
Case in mind, this patient had been referred from one specialist to another, by his family physician who won't even return his phone calls anymore. After I told him his symptoms were nonspecific and something I can't explain from my standpoint, he shares: "I just want to move on with life, not have my doctor lead me on a 7-physician wild goose chase". I was one of the few physicians who didn't promise that the cardiologist/rheumatologist/someone else would solve his problem- I just plain said I don't know. We both agreed that sometimes 'no news is good news' and while we may never explain why he feels the way he does, life has to go on.
But I did appreciate his comments, as he appreciate my honesty.

2 Comments:

Blogger lucy said...

hi there,

i was taught in UK, and experienced it myself, that pts would appreciate it if you told them the truth that you don't know (and will find out).

but in singapore, i find that if you say that, pts will take a very nasty approach and say you are an inferior doctor. Had some bad experiences. Interestingly enough, i believe they would rather a confident doctor tell them something inaccurate she is not sure of than play the honesty card

10:06 PM  
Blogger vagus said...

that's true, i suppose some patients wouldn't appreciate hearing that.
the problem with not knowing, is sometime you never will find out the problem.

9:09 PM  

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