Home | Biography | Forty-Eight X | Future Books | Stories | Credits | Contact

The Candid Doctor

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 time."

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.