The best doctors are the ones who aren't afraid to say, "I don't know" or "I'm not sure." The most dangerous are the ones who think they know but don't.
--Oncologist, Santa Cruz, California--
Doctors are on my mind.
My husband & I are just back from Florida after visiting his mother who is newly diagnosed with ovarian cancer. Part of the visit was a chance to talk with her local oncologist, the one who "delivers her chemotherapy". His mother had lots of questions--and so did we.
Why is it sometimes so hard to get straight understandable answers from doctors? The oncologist talked to us for almost an hour. An extraordinary amount of time for a busy physician. He was compassionate. We were grateful. But in truth, he never really read my mother-in-law's medical record until my sister-in-law asked him point blank if he had. He was unfamiliar with the details of her case. And he never answered any of the important questions we had come there to ask. In fact, he didn't really give us much of an opportunity to ask. Too bad he never told us the obvious--that we really should be talking to her gynecologic oncologist who knew the case, but was 2 hours away.
My mother-in-law left his office satisfied because he was kind, funny and gave her a hug. I felt oddly unsatisfied, like we had an important fact-finding mission to complete & we had come away empty-handed. The next day when my mother-in-law said to me, "Gee, I thought you would have a lot more questions for the doctor," I felt I had let her down.
What Doctors Think
In truth, I know doctors have a difficult, often frustrating job. And I can't think of a job more fraught with the land mines of time constraints, difficult diagnoses, uncooperative patients, the insurance industry & our legal system. When my friend Suze gave me a copy of Dr. Glenn Colquhoun's poem that appeared in the New Zealand Medical Journal 119(1239):U2098, 2006, we both agreed that doctors have it tough.
Today I Do Not Want To Be A Doctor. -by Glenn Colquhoun, A New Zealand poet, physician & children's author-
Today I do not want to be a doctor.
No one is getting any better.
Those who were well are sick again.
And those who were sick are sicker.
The dying think that they will live.
And the healthy think they are dying.
Someone has taken too many pills.
Someone has not taken enough.
A woman is losing her husband.
A husband is losing his wife.
The lame want to walk.
The blind want to drive.
The deaf are making too much noise.
The depressed are not making enough.
The asthmatics are smoking.
The alcoholics are drinking.
The diabetics are eating chocolate.
The mad are beginning to make sense.
Everybody's cholesterol is high.
Disease will not listen to me.
Even when I shake a fist.
What Your Doctor Never Tells You
If you haven't seen it already, the July 2008 Reader's Digest has an eye-opening piece, called "41 Secrets Your Doctor Would Never Share (Until Now)." They gave 24 doctors the chance to tell it like it really is. The group included family physicians, surgeons, psychiatrists, pediatricians, cardiologists and other specialists. Some wanted to be anonymous, others didn't care. It's information that can help us be better patients. Here are my favorites.
- I am utterly tired of being your mother. Every time I see you, I have to say the obligatory "You need to lose some weight." But you swear you "don't eat anything" or "the weight just doesn't come off," and the subject is dropped. Then you come in here complaining about your knees hurting, your back is killing you, your feet ache, and you can't breathe when you walk up half a flight of stairs. So I'm supposed to hold your hand and talk you into backing away from that box of Twinkies. Boy, do I get tired of repeating the stuff most patients just don't listen to. --Cardiologist, Brooklyn, NY.
- I wish patients would take more responsibility for their own health and stop relying on me to bail them out of their own problems. --ER physician, Colorado Springs, Colorado.
- So let me get this straight: You want a referral to three specialists, an MRI, the medication you saw on TV, and an extra hour for this visit. Gotcha. Do you want fries with that? --Anonymous
- Your doctor generally knows more than a website. I have patients with whom I spend enormous amounts of time, explaining things and coming up with a treatment strategy. Then I get e-mails a few days later, saying they were looking at this website that says something completely different and wacky, and they want to do that. To which I want to say (but I don't), "So why don't you get the website to take over your care?" --Anonymous
- Sometimes it's easier for a doctor to write a prescription for a medicine than to explain why the patient doesn't need it. --Cardiology, Bangor, Maine.
- Avoid Friday afternoon surgery. The day after surgery is when most problems happen. If the next day is Saturday, you're flying by yourself without a safety net, because the units are understaffed and ERs are overwhelmed because doctors' offices are closed. --Heart Surgeon, New York City.
- Often the biggest names, the department chairmen, are not the best clinicians, because they spend most of their time being administrators. They no longer primarily focus on taking care of patients. --Heart Surgeon, New York City.
- It saddens me that my lifelong enjoyment and enthusiasm for medicine has all but died. I have watched reimbursement shrink, while overhead has more than doubled. I've been forced to take on more patients. I work 12- to 14-hour days and come in on weekends. It's still the most amazing job in the world, but I am exhausted all the time. --Family Physician, Redding, CA.
- In many ways, doctors are held to an unrealistic standard. We are never, ever allowed to make a mistake. I don't know anybody who can live that way. --Anonymous
- Not a day goes by when I don't think about the potential for being sued. It makes me give patients a lot of unnecessary tests that are potentially harmful, just so I don't miss an injury or problem that comes back to haunt me in the form of a lawsuit. --ER physician, Colorado Springs, CO.
- Plan for a time when the bulk of your medical care will come from less committed doctors willing to work for much lower wages. Plan for a very impersonal and rushed visit during which the true nature of your problems will probably never be addressed and issues just under the surface will never be uncovered. --Anonymous.
- At least a third of what doctors decide is fairly arbitrary. --Heart Surgeon, New York City.
As for our visit to my mother-in-law's oncologist.... In 10 days we'll return to Florida and talk to the gynecologic oncologist who is in the best position to answer her questions.