Saturday, April 19, 2008

What trickery is this?

As soon as we opened the door to the clinic room, we could see the worry written all over her face. She sat in the chair, legs together, purse on her lap, and tightly clutching a piece of paper with notes scrawled all over.

Prompted by the doctor, I began asking her questions about why she had come in. While at first she complained of generalized fatigue, she quickly admitted, "But that's not really why I'm here. I had a question about my son's asthma treatment."

"Go ahead," said the doctor.

"Is it true that asthma puffers can make him committ suicide?"

"Well, actually, I haven't heard anything about that," he replied. "There are a lot of side effects for asthma medication, but depression isn't usually listed as one of them."

She didn't respond to his question. Instead, she shoved towards him another piece of paper that she had been holding - one with a printout of a newspaper article. I read the headline upside-down: "Asthma Drug Questioned for Suicide Risk."

The doctor read over the article, then handed it to me. Her concern was justified, but it only took a few seconds to tell that the patient was reading a little bit too much into the article. First of all, it was written in a sensationalist manner, written by a health website but not a reputable news source. Secondly, the article said nothing about a proven association - just that the link was about to be investigated further. And third, as the doctor clarified later, the article was about an asthma medication that her son wasn't even taking - a pill, not the puffer.

Not only that, but I didn't fault the doctor at all for not being aware of the news. The article had come out that day, and was based on a paper that was going to be published in a medical journal the next week.

We explained to her these things, but I couldn't help but think that I was a little disappointed in the patient. Instead of showing him the article right off the bat, she had asked her doctor a loaded question, one to which she knew the answer, but she wanted to see what he would say anyways. Not only that, but it was on a very recent topic... was she expecting him to be aware of every recent medical development on a suspected association, not yet accepted as a standard of care?

It reminded me of another patient who told me that she once asked her doctor for penicillin to treat a cold, then when he prescribed it to her, confronted him with the fact that she was allergic to penicillin.

Obviously there are two sides to these issues, but I still wondered how I would feel if I thought a patient had tricked me. It's true that doctors are expected to make few, if any, mistakes, and it's definitely good to have someone check up on you once in a while, but it might also prove difficult for me to be in a doctor-patient relationship in which the patient is frequently trying to get me to say something wrong. After all, trust in the doctor-patient relationship goes both ways.


Anonymous said...

As a patient, I think you're reading too much into how the patient approached the doctor with this question. Granted it would have been better for the patient to have prefaced her question with showing the article first, but it's a stretch to accuse her of "tricking" the doctor into making a mistake.

When patients comes in, they are confused, scared, upset. They are coming in for answers and hopefully for their medical problem to be resolved. The doctor is supposed to be the steady hand here. They shouldn't be so sensitive if an unsophisticated patient doesn't have the verbal skills to present their case properly. Just curious, did the attending have the same opinion as you?

Vitum Medicinus said...

The attending wasn't as surprised as I was... he was just glad that he answered in a way that didn't make him look too stupid!

Jessica said...

The attendings answer was correct though... because she asked about the puffer not a pill.

I also think you might be reading into this a bit too much.

I know that I am terrifed when ever I have to ask my doctor a question based on something I found or researched.

I fear that they may not know about it, or that I was reading it the wrong way, the way this woman did. Then I get to feel like the idiot.

I also fear that the doctor doesn't want me to being in stuff printed off the interent and that by doing my own resaerch I'm trying to take over their job or something like that.

Neumed said...

I wasn't there, but I have to agree with the other comments. I doubt that the patient came in with the intention of tricking the doctor. She was just worried and didn't quite know how to ask her question without offending her physician.

Speaking merely as a patient, (and not as a med student) when I visit the doctor for any reason, my goal is to obtain the best medical care and as much understanding of the situation as possible. I have zero interest in embarrassing the MD.

Granted there are some real wackos out there, but this seems more like just a concerned mother seeking some reassurance that her son was on the proper meds.

Anonymous said...

I rather agree with the other comments BUT I have asked questions that I know the answers to before. Not about a brand new article, but about more general subjects. As an expert patient with Fibromyalgia, which is little studied by most doctors, asking questions like this can be a good way of judging the doctors knowledge. I don't aim to embarrass the doctor and would soemtimes not even point out a mistake - but I might not see that doctor again.