Trust Your Doctor! Or not.

All doctors get dogged by patients and parents for missing diagnoses.  I see it when a parent brings their child into the Emergency Department.  The kid has had a cold and fever for a few days, and their regular doctor called it “just a cold.”  When I examine the child, I find an ear infection.  The parent then says something like “Thank God I brought the baby back!  That other So-and-so missed the ear infection!”

At this point many doctors, including me, are tempted to take credit for being smarter than their colleague, and let the parents leave with the notion that I am somehow superior. Taking credit for hindsight, however, is unfair to the first doctor.  Diseases progress.  What started as a cough and runny nose virus in the child above can later, after the first visit, develop complications like ear infections or pneumonia.  I too have been complained about when I have diagnosed a cold virus, and later when the child was taken to another doctor, she was then diagnosed with pneumonia.  The family then complains because I “missed the diagnosis,”  even though pneumonia naturally develops later in cold viruses and the child truly had no pneumonia at the time I saw her.

Why do some families easily distrust a doctor?  There are several reasons, some because of the family, some because of the doctor.  The first family factor is that families care.  They love their child and when things go wrong they get worried, they get scared, they get angry.  Another factor is that families often know about someone who got sick, the doctor said things will be fine, and the patient went on to have cancer or worse.  Those family stories color any future encounter with a doctor.  Finally, people have come to take their child’s good health for granted and now expect only good outcomes from illness. One hundred years ago, every family was expected to bury a child or two because there were more deadly diseases around, and few effective treatments.  Now when things go wrong in any way, people are shocked and surprised, and angry.

Often, doctors don’t help families trust them either.  Doctors often seem too rushed to listen and examine patients carefully, and thoughtfully consider the diagnosis.  Doctors in practice are busy trying to see so many patients in a day, when there are weeks-long waits for patients to get an appointment.  Emergency Department doctors are in a hurry to see patients to clear the way for the next surprise emergency to rush through the doors.

Also, a doctor doesn’t usually get into medical school because he is a warm and fuzzy “people person.”  The main criteria for medical school admission is academic ability- being great at science and math.  But school smarts don’t not always go with charm and empathy.  Sure, medical schools are trying to let in fewer Sheldon Cooper types like from the TV show The Big Bang Theory.  But medical schools don’t yet have a really good way to figure out who is going to be a smart and caring doctor, and who will just be a medical nerd.

Finally, doctoring is difficult because medicine is a hard discipline.  Disease diagnosis is sometimes complex, and medical science’s understanding of disease and its progression is imperfect.  There is a lot to know, and a lot more that is unknown.  The best doctors get surprised by their own ignorance.  And in a difficult, stressful, and tiring profession, doctors get stressed and tired.  Then your doctor is really not good company.

So what do we want in a doctor, so we can trust him or her?  We want a doctor who is really smart and experienced.  We also want that doctor to be caring, to take time to listen to our problem, to be friendly and to like us and to do their best to help us.  Fortunately most doctors are just like that most of the time.  Only seldom is a doctor not smart or not caring.  If your doctor seems ignorant or uncaring every visit, change doctors.  And sometimes you have to give your doctor a break in order to continue to trust him.

Or not.



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