Saturday, January 31, 2009

Obligation or not?

As physicians, we’re all aware of the frustrating “medical mystery.” These are the cases that initially look straight-forward, but then veer from the expected path when laboratory and/or imaging results fail to show the anticipated results. We do more digging, we sort through our text books, we perform internet searches. We reassess the patient; we comb through the history for something we’ve missed. Often, with diligence, we’ll find a piece of the puzzle that points us in the direction of a solution.

But what happens when that piece of the puzzle remains elusive? Where do we go? Most of us have a game plan for those cases that don’t seem to have any answers no matter where we turn. And often, our patients are satisfied with our attempts - even if no answer is found.

But what about the medical mystery that isn’t our patient – but the child of a friend or an acquaintance? What’s the best response when that friend asks for advice or an opinion? How much effort have you (or would you) expend in such a circumstance? I think that we’ve all expended some informal efforts regarding kids – an otoscopic evaluation here (a neighbor calls on a Sunday afternoon and wonders if a trip to the ER is warranted), a concussion assessment there (you’re at the playground and watch a child fall off the slide) – but what’s your comfort level regarding something that doesn’t seem to have an answer?

As with the mysteries mentioned above there many not be one specific answer (and certainly not a “right” or “wrong” response!), but I am interested in knowing your opinions when faced with this issue.
A

5 comments:

  1. I don't think I've been in the situation where it is involving a friend or acquaintance, but sometimes, all you can do is reassure that we don't think it's ____ (pt's fear), to really explain what we can tell and what we can't...it's wholly unsatisfying.

    Especially when people assume that we have all the answers or should have all the answers.

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  2. I've been in this situation a few times and have tried to be as supportive as I can without actually getting sucked into solving the problem. I will help the patient/family understand and navigate the process, but generally keep my mouth shut about the conclusions (or lack thereof) except to say that it's easier to rule stuff out than to rule stuff in.

    I tend to hold my boundaries with my friends and family further away than my doc friends - I am fairly uninvolved compared to most of them. So I have a lot of practice at not commenting.

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  3. If non-medical friends ask, I advise you "stay clear" of any advice or reassurance. You may be sucked into the problem in a way that can destroy the friendship, sometimes because of eventual resentment on your part. You are flattered to be asked; then find out you are number 9 on a list of 10 calls. You then find out that your comments are overruled by their nextdoor neighbor's hairdresser's opionion on same topic. (I don't exagerate - after several decades of medical practice my advice to an acquaintance was ignored in favor of the highschool graduate church ladies' recommendations. And a disaster occurred. Since I had been sucked into the dialogue to start with, I was now phoned at all hours with the disaster symptoms). You can recommend a respected colleague for an official visit. Because, compared to some things in life that are described as win-win, this situation is lose-lose for you. You don't know a)what did the physician of record really think or diagnose or say, b)what did your friend hear and c)what part of the story did the friend not give you. You will get no thanks for any correct reassurance, you will be blamed for anything that doesn't go right.

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  4. With friends I now stop and ask them, "Are you looking for advice or empathy?" Most of the time they want empathy- and I'm off the hook.

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  5. Thanks for the comments and insights; you're echoing what I've been feeling. Someday (much) later I may be able to share the story which prompted the post...
    A

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