Providing ambivalent medical advice

When did some doctors become so wishy-washy?

A large part of what we do is guide people through an often-confusing maze of test results and treatment options. I respect patients’ right to make their own decisions, but it came as a surprise to me to find that some doctors are turning such things over to the patients. After all, doctors are the ones who went through over a decade of training to understand the risks, benefits, and goals of each step for them. Granted, I live in Arizona, where you don’t need a doctor’s order to have labs done. You can research whatever you want on Google, decide what work-up you need, and go get whatever labs you want done.

But back to my original point. Recently, one of my patients was admitted to the hospital, then followed up with me in the office. I looked through his test results and told him what I felt the next step should be, ordered a few things, and wrote an instruction sheet to start daily aspirin. I commented that it surprised me the last hadn’t been done as an inpatient.

His answer? “They said I could if I wanted to, but didn’t make a clear suggestion.” I figured this was a simple miscommunication, so I pulled up the hospital chart on my computer. There I found a note from the attending that said, “The patient was told he may or may not want to take a daily aspirin, and that doing so might or might not be to his benefit.” What on Earth?

I understand there are no guarantees in this job. There’s no crystal ball to know for sure that what we’re doing is right. Any drug can cause serious and unexpected complications. We take calculated risks and hope we come out ahead. But to phrase it like this? Where the patient isn’t given the guidance we’re supposed to provide? What’s the point of even being a doctor?

Since then, I’ve noticed similar phrasing in other charts: “We discussed doing a brain MRI, and she’ll let me know what she decides” and “I told her that starting Lamictal may or may not prevent seizures, and to consider it as something she should or shouldn’t do.”

I’m sure some of it is part of the hurried flight-of-ideas dictations we all do when we’re busy at the hospital. There’s also a component of legalese to make sure that we documented discussing risks with the patient.

But I still don’t get the ambivalence. In similar situations, I provide guidance and advice and tell people what I think they should do. I’m not going to force anyone to do anything they don’t want to. If they disagree, I note it and make whatever suggestions I think will help. In the end, it’s their decision. I get that.

When I take my car to get fixed, I don’t want the mechanic to tell me what may or may not need to be repaired, and I hope patients see me the same way.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

When did some doctors become so wishy-washy?

A large part of what we do is guide people through an often-confusing maze of test results and treatment options. I respect patients’ right to make their own decisions, but it came as a surprise to me to find that some doctors are turning such things over to the patients. After all, doctors are the ones who went through over a decade of training to understand the risks, benefits, and goals of each step for them. Granted, I live in Arizona, where you don’t need a doctor’s order to have labs done. You can research whatever you want on Google, decide what work-up you need, and go get whatever labs you want done.

But back to my original point. Recently, one of my patients was admitted to the hospital, then followed up with me in the office. I looked through his test results and told him what I felt the next step should be, ordered a few things, and wrote an instruction sheet to start daily aspirin. I commented that it surprised me the last hadn’t been done as an inpatient.

His answer? “They said I could if I wanted to, but didn’t make a clear suggestion.” I figured this was a simple miscommunication, so I pulled up the hospital chart on my computer. There I found a note from the attending that said, “The patient was told he may or may not want to take a daily aspirin, and that doing so might or might not be to his benefit.” What on Earth?

I understand there are no guarantees in this job. There’s no crystal ball to know for sure that what we’re doing is right. Any drug can cause serious and unexpected complications. We take calculated risks and hope we come out ahead. But to phrase it like this? Where the patient isn’t given the guidance we’re supposed to provide? What’s the point of even being a doctor?

Since then, I’ve noticed similar phrasing in other charts: “We discussed doing a brain MRI, and she’ll let me know what she decides” and “I told her that starting Lamictal may or may not prevent seizures, and to consider it as something she should or shouldn’t do.”

I’m sure some of it is part of the hurried flight-of-ideas dictations we all do when we’re busy at the hospital. There’s also a component of legalese to make sure that we documented discussing risks with the patient.

But I still don’t get the ambivalence. In similar situations, I provide guidance and advice and tell people what I think they should do. I’m not going to force anyone to do anything they don’t want to. If they disagree, I note it and make whatever suggestions I think will help. In the end, it’s their decision. I get that.

When I take my car to get fixed, I don’t want the mechanic to tell me what may or may not need to be repaired, and I hope patients see me the same way.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

When did some doctors become so wishy-washy?

A large part of what we do is guide people through an often-confusing maze of test results and treatment options. I respect patients’ right to make their own decisions, but it came as a surprise to me to find that some doctors are turning such things over to the patients. After all, doctors are the ones who went through over a decade of training to understand the risks, benefits, and goals of each step for them. Granted, I live in Arizona, where you don’t need a doctor’s order to have labs done. You can research whatever you want on Google, decide what work-up you need, and go get whatever labs you want done.

But back to my original point. Recently, one of my patients was admitted to the hospital, then followed up with me in the office. I looked through his test results and told him what I felt the next step should be, ordered a few things, and wrote an instruction sheet to start daily aspirin. I commented that it surprised me the last hadn’t been done as an inpatient.

His answer? “They said I could if I wanted to, but didn’t make a clear suggestion.” I figured this was a simple miscommunication, so I pulled up the hospital chart on my computer. There I found a note from the attending that said, “The patient was told he may or may not want to take a daily aspirin, and that doing so might or might not be to his benefit.” What on Earth?

I understand there are no guarantees in this job. There’s no crystal ball to know for sure that what we’re doing is right. Any drug can cause serious and unexpected complications. We take calculated risks and hope we come out ahead. But to phrase it like this? Where the patient isn’t given the guidance we’re supposed to provide? What’s the point of even being a doctor?

Since then, I’ve noticed similar phrasing in other charts: “We discussed doing a brain MRI, and she’ll let me know what she decides” and “I told her that starting Lamictal may or may not prevent seizures, and to consider it as something she should or shouldn’t do.”

I’m sure some of it is part of the hurried flight-of-ideas dictations we all do when we’re busy at the hospital. There’s also a component of legalese to make sure that we documented discussing risks with the patient.

But I still don’t get the ambivalence. In similar situations, I provide guidance and advice and tell people what I think they should do. I’m not going to force anyone to do anything they don’t want to. If they disagree, I note it and make whatever suggestions I think will help. In the end, it’s their decision. I get that.

When I take my car to get fixed, I don’t want the mechanic to tell me what may or may not need to be repaired, and I hope patients see me the same way.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.