Notes from an emergency room doctor: I've been
shopping for a computer lately. Browsing through
computer stores, the "expert" salespeople
always sound pretty erudite about their products.
But often, when you stand before a computer and
ask them for help, they muddle with the keyboard
and can never get some awfully expensive machine
to do the simplest of tasks. Usually, they have
a great excuse like, "the batteries are low,"
or "someone messed with the machine and deleted
part of the disk." No one ever says: "These
are intricate machines. And, to be truthful, there
are so many different kinds; I can't be an expert
on each one." The problem is that kind of
candor doesn't make a sale.
Doctors, like salesmen, like to please their
customers too. So, being completely candid with
a patient is not the easiest thing for a doctor
to do either. For instance - A small child is
brought into the emergency room late in the evening,
long after everyone's bedtime. "He's been
up crying all night," Mom explains. "I
think he has an earache." The doctor performs
a physical exam, leaving the child's ears, which
seem to be the cause of his restless night, for
last. The child, afraid and uncomfortable, screams.
His parents are anxious and upset. But to make
a diagnosis, the doctor needs to see the child's
eardrums. But he can't see them. In many children
eardrums can't be visualized because of an accumulation
of wax. What's wrong with my child, the parents
want to know? The doctor can't be certain. But
here are his options.
"Well, Mom, to make an accurate diagnosis,
we're going to have to wash out his ears."
Mom's not going to be happy with this effort as
her child wreaks havoc on everyone's eardrums
screaming through the whole procedure. And perhaps,
from the trauma of irrigation, there will be some
bleeding. Nothing serious but enough to drive
the parents to call 1-800-SUE-D-DOC.
Or the doctor can say, "Well, Mom, I can't
see his eardrums but - probably - he has an ear
infection." But admitting that a diagnosis
is a guess doesn't instill confidence.
Or he can say, with conviction, "He has
an ear infection." Now that's a lie. An educated
guess but a lie nevertheless. Mom and child will
go home with a prescription that will let them
both sleep. And they'll probably be very happy
with their doctor's care.
Strictly honest communication is difficult.
Partly to blame is our horrendous medicolegal
climate where anything less than a perfect outcome
is grounds for a lawsuit. But part is due to the
fact that doctors, like salesmen, want to please
and keep their clients.
While dictating a chart of a case where a patient
has died, I have thought how easy it would be
to dictate as well a brief letter to the family
candidly admitting that we in the emergency room
are also distressed by a death. "My staff
and I extend our heartfelt condolences on your
loss," I could simply write. But I've never
sent that kind of letter. I don't think people
will say, "What a wonderful caring doctor."
I think someone in the family will read the letter
and say, "that doctor feels guilty about
something. We better hire an attorney to see if
he did something wrong."
Isn't it a shame that doctors and computer salespeople
just can't come out and say, "We do the best
we can but things don't work perfectly all the
I think I'll finally buy a computer from a less
than candid salesman. I guess it's better that
way. If they were totally honest, I'd probably
never buy one.