By Dr. Paul Ehrlich
A recent article in the New York Times “Afraid to Speak Up in the Doctor’s Office” by Pauline W. Chen, MD, a transplant surgeon, gave the following account of a phone conversation with a friend about a recent medical episode:
“[W]hen I suggested she speak with her primary care doctor and perhaps a neurologist, her end of the line went silent. I wondered if my cellphone had dropped the connection or, for a single harrowing second, if my friend was having another strokelike event. When she finally spoke again, her once-confident voice sounded nearly childlike. “I don’t really feel comfortable bringing it up,” she said. While her doctor was generally warm and caring, “he seems too busy and uninterested in what I feel or want to say.”
“I don’t want him to think I’m questioning his judgment,” she added. “I don’t want to upset him or make him angry at me!”
What is it about doctors and patients these days? Are we physicians really that forbidding? Are patients really so scared of us? Does a prolonged stay in the waiting room set a mental alarm clock in a patient’s head that cautions against asking a nagging question or mentioning some additional symptom that might lead to more time, tests, co-pays, and prescriptions or other bad news? You don’t have to be as cynical as Dr. House (“everybody lies”) to think that patients (and doctors) don’t always tell the truth, the whole truth, and nothing but the truth.
We certainly get a taste of the communication gap at Asthma Allergies Children world headquarters as we monitor various discussions on the web. We like the idea of peer exchange. It arms patients and patients’ parents with knowledge to share with their doctors, which makes the doctors better at what they do. Now and then, however, we see threads that beg the question, “where are the doctors?” Why are people pursuing lines of thinking that an MD could clear up in a moment? When it comes to feeding a food-allergy family, the average parent after a while probably knows much more than the average allergist, and peer-to-peer communication helps more than the doctor. But that board certification in allergy and immunology carries some weight, too. Yet, it is clear from the back-and-forth that consulting the doctor is a last resort. This does a disservice to both sides. It may not be easy to get an appointment with your allergist, but when you get there don’t worry about wasting her time, or his. There are no trivial questions.