I agree with your analogy to your computer guru, but there is another element that is common to both professions: Technospeak.

In both the medical and computer professions (and many other specialized fields, I'm sure), there is a tendency for the practitioner to hide behind words that they know even a well informed client / patient won't have a prayer of fully understanding.

On some level I can accept this. There are legal implications to stating something that can/should not be expressed in absolutes. There is also the natural inclination to want to shield people from bad news.

For example, telling a patient or family member that there is a 'less than optimal prognosis for a meaningful recovery' is (IMHO) a cruel way of avoiding the words 'you (or your loved one) will probably never wake up/walk/talk/whatever again.

A poor prognosis is something nobody wants to hear... but a vague explanation that does not give a person or his/her family the opportunity to make important decisions and/or give closure is a very troubling (and common) phenomenon.

Also, I have had limited experience with medical folks who are incapable of saying 'I don't know'. We have elevated physicians to a level that makes it difficult for them to admit limitations, or for us to accept them. This is also a bit dangerous.

Think about the most powerful scenes in TV or movies involving a terminal illness or injury. They aren't the ones where someone dies quickly or in blissful ignorance. They are the scenes where the medic/doctor/army buddy/whoever is asked by the mortally wounded/terminally sick person "Is this it? am I gonna die?" And the answer is a firm nod or a brief word in the affirmative. As an observer we are then satisfied that the person can 'make his peace' or look back on his life, or say his good-byes. In short, the person who is poised at the jumping-off point is treated like an adult and told the simple truth that we all must one day face.

I know this has been rambling and long-winded, but I think I have been most appreciative of medical professionals when they have spoken to me as a peer... as somebody who needs to understand the details... as a partner in the process.

It sounds like you are the kind of physician that I would like.

~treppenwitz~
 

Ladies and gentlemen, please rise. Mr. David Bogner is in the room. Welcome!

It's such a weird coincidence, you hit on my pet peeve. I hate it when doctors use terms that the patient has no way of knowing. During my residency, I would jump all over interns who did that.

"Did you know the word cardiomyopathy before you went to med school?"
"No."
"Then why did you just use it with Mrs. Jones?"

Especially since, if one is aware of the words one uses, and if one thinks the patient is capable of learning, one can use the opportunity to teach by saying something like "You have what doctors call 'cardiomyopathy' which is an enlargement of the heart chambers in which the heart doesn't beat as strongly as it should." There. That wasn't rocket science was it? I frequently thought that it is because I am an immigrant that I'm used to translating in my head and being very careful that I pick words that are understood. (And it makes me very intollerant of technospeak in other fields. The computer guru wasn't born knowing all the words he uses. Why won't he translate for me?) I'm also lucky that I had a great medical ethics teacher. Even though it was a tiny fraction of my training in terms of hours, it gave me priceless lessons like how to give bad news, what the legal and ethical differences are between euthenasia and withdrawal of care, and who decides which plan of treatment to pursue. What I wasn't taught was that this brief training would be responsible for all of the gift baskets I get.
 

This confabulation, while somewhat palaverous, has been most edifying.
 

Ralphie: You really should eschew obfuscation.
 

AOL: thank you. I appreciate it.
 

I admit it: I am very sensitive to the grief and suffering of others. I wonder if doctors become desensitized to that.
 

Doc Bean has some excellent thoughts on medical costs that on which I hope he'll make a separate post someday. I bring it up because I believe it ties into the expectations-game he touches on in his post.

I don't know what the doctor actually earns for an office visit, once the various involved parties have taken their cut. I do know that what it COSTS however. The fact that my insurance company pays much of these costs is of little comfort, since I pay my insurance company a bumload of money every month for the priveledge.

The expense of medical care has gone from expensive to lunacy over the past few decades. A friend of mine, without insurance, recently received a bill for a half-million dollars for his bypass surgery. He's a bartender in his late 60s without insurance. He probably hasn't earned a half million dollars in his entire adult life.

My point is that people expect perfection from their doctors with respect to diagnoses and treatment because this care is the most expensive service they purchase in their daily lives. There aren't money-back-guarantees for poor quality-of-treatment, and we aren't given quotes ahead of time on which to make financial decisions. I believe that this, as much as anything else, is why the average patient is unimpressed with good service; it's simply expected.

This may not be as much of an issue for a practice in an affluent Southern California community as it is in other parts of the state and country. Still, I think it plays a role.
 

Oven and I had an interesting email exchange about this, and with his permission, I’m adding it here. I’ve edited it so that it reads chronologically and redacted identifying info:

Oven wrote:

Hi [Bean],

I posted a comment to your Thank You, Doctor post.

I was actually hoping for some insight.

Are doctors desensitized to suffering because they see it all the time? [Mrs. Oven] tears up when [our son] gets a shot, and I'm not much better. I've been to quite a few funerals and they never fail to affect me.

[Oven]
--------------------

Doctor Bean wrote:

I honestly don't know. Some people are insensitive regardless of how much or little suffering they've seen. Some doctors may act cold because they never connect with patients at all on an emotional level and feel like they see too many patients to bond with any. I'm not sure what you mean by desensitized, or how a doctor would act to have you think he was desensitized. I certainly don't cry when I give bad news, but I use words that make it clear that I understand the emotional content of what's happening ("I have some terrible news."), and I use body language that is reassuring. I always sit, not stand. The situation is usually terrible enough without me emoting myself, and I think that patients get comfort from (1) knowing that I understand the emotions that they're having (2) seeing that I can stay composed and make a rational plan. If they're tearing up and panicking, they don't need me to do the same. They need me to sit quietly, look at them, and hand them a tissue, and wait for them to quiet down so we can continue.

If you mean doctors that are cold jerks, I suspect that they were always cold jerks and that the amount of suffering that they've seen is irrelevant. I thought in medical school that practicing medicine would make me react less to suffering. The opposite has happened. I know now that horrible things can happen to anyone without reason or warning. I'm much more terrified and anxious about disease than I used to be.

I have no idea if I answered your question. Let me know.
--------------------
Oven wrote:

A scenario. You have a patient and he dies from something terrible. The kids, maybe the grandkids, they're all crying. That would make me sad. Maybe not crying sad, but really sad just the same.

My question is: Does that make YOU sad? And, more generally, do doctors become less sad the more
suffering they see?

I understand that doctors may SHOW sadness, or sympathy, or whatever, whether or not they feel it. There may be standards as to what is appropriate professional conduct in sad situations. But I'm not really asking about any of that. I'm asking about feelings, and your answer is interesting to me because I might infer from it that your thinking side is more dominant that your feeling side, if you believe in those personality tests.

[Oven]
--------------------
Doctor Bean wrote:

Now I understand your question.

I definitely feel sad in those situations. I sometimes tear up a little bit, but I try to do that afterward, not when I'm with the family. [ball-and-chain], who never meets these patients, just sees their names on insurance forms, hears the stories from me and feels sad. In fact, I remember telling myself that if I ever get to the point that it doesn't make me sad, I would look for different work.

I don't think that the more suffering doctors see the less sad they feel. I've talked to oncologists who are at least 10 years older than me. They say that the emotional toll gets worse the longer you do it because more and more of the dying patients are the same age or younger than them. They still definitely feel sad, and they see way more dying patients than me and have been practicing longer.

I also know an oncologist who is a jerk and is never comforting to his patients' families. I assume (but don't know) he was a jerk from the start.