Thursday, November 01, 2012

Oxymoron of the day - Straight-talking Doctor

kw: human nature, human relations, doctors

Doctors see a lot, much of it tragic. And many of their patients do not particularly want to know what is really going on. I imagine this is the reason most of them have lost the ability to speak in clear terms. I have had the misfortune to be a patient of many doctors, and only two, my current G.P. and my gastroenterologist (or GI), seem able to speak frankly, avoiding vagueness or even untruth.

At the time I had cancer surgery, there were four doctors involved: The G.P. I had at the time, the same GI I still have, the surgeon, and an oncologist. I clearly remember when I met the oncologist, two days after the surgery, he said he was optimistic because my cancer was Stage 2. When he left the room, he talked to a nurse right outside the door, and told her, "Late Stage 3." Only weeks later did I get a chance to pin him down, without letting him know what I'd heard, and got him to admit Late Stage 3, and that he was most concerned because 7 lymph nodes had been cancerous; the threshold of worry is 4. Thereafter, he was more forthcoming with genuine information.

During the hospital stay, the surgeon and the GI came by to see me, at different times. I asked each for a prognosis. The surgeon would only say, "Well, the cancer was rather large, and I had to remove a lot of stuff, but I think Dr. [Oncologist] will be able to help you a lot." But the GI said, "It looks pretty bad. Dr. [Surgeon] is excellent, and he thinks he dug out everything." I asked what the percentages were, both with and without chemotherapy (I was still mad at the oncologist for what I'd heard). He looked right at me and said, "Today, you have a 15% chance of one year survival. With chemo, it ought to improve by 25% or 30%, to the 40-50% range."

My G.P. came by a couple times, but he was clearly clueless. I realized he was too young, and afraid to speak in any quantitative way. Hey, I am a quant kind of guy, and I am hardheaded enough to take a frank assessment about the chances of my own demise. My primary desire to avoid death was that my son was only 12 at the time.

Fortunately for me, that G.P. moved his business 30 miles away, so I went looking for a new doctor. The one I have now is a great deal better. He is old enough to know the score, but not so old that he'll retire any time soon. During my physical a few weeks ago, I told him I appreciated how clearly he would say things. He said something about being frank, "perhaps too frank." I said, "Just remember the motto of the Diplomacy Dept.: We say the awfullest things in the nicest way." And I told him I thought there was no such thing as too much information.

I feel very lucky. The stories I hear from others, you'd think their doctors went to school to learn how to be vague. Just today it occurred to me, they are like teenagers who don't want to tell Mom where they were, who was there, or what they did. Their arsenal is every vague term in the book: Some, More-or-less, Kind of, Perhaps. I realize not all medicine is cut-and-dried, quantitative knowledge. But, doc, if you know something, tell it to me clearly. Thank you.

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