WhiteCoat

Assuming the Worst

rotor-brake-caliper-brake-padsYesterday happened to be the day that the brakes went bad on my truck.

For the past week I’d been getting the “squeeking” sound when I put on the brakes and had planned to replace the pads today, but yesterday while driving home from a trip, there was the dreaded “grinding” metal-on-metal sound that means your rotors are getting torn up. I just had new rotors put on my truck about 8 months ago, so I didn’t want to put off changing the brake pads any longer.

I stopped at the auto parts supply store and bought brake pads on the way home.

Before I go further, I  have to admit that I know enough about cars to get by, but I’m nowhere near a mechanic. I do my own tune ups, change my oil, change my brakes, and even do my own wiring for stereos. When things get more complicated than that, I leave it to the experts. Changing belts and replacing major parts is out of my league. When the dealer replaced my rotors, it cost me more than $600. What can you do? You have to pay it.

I put the truck up on a jack and pulled off the wheel, exposing the brake caliper (upper left) and the rotor (round shiny thing in center of picture). After I pulled off the brake calipers, sure enough, the brake pads were worn flat. You can see the brake pad sitting on the floor at the bottom of the picture.

Then I noticed something that got me angry.

There are two screw holes (red arrows) on the rotor that hold the rotor in place. The screws were missing and the rotor was flopping back and forth on the wheel hub.
The damn dealer forgot to attach the rotor to the wheel hub when it replaced the rotor.
I pulled off the other wheel. Same thing! The rotor was just flopping there.

What if the rotors came off while we were driving home earlier in the day? My family would have been a statistic. We’d all be dead.
I called the auto supply store I usually go to. They don’t stock bolts like that. “Why wouldn’t they replace them when they changed the rotor?” the parts guy asked.
I called several other supply shops. None of them stock bolts like that, either. The last store I called told me that I’d have to call the dealer in the morning before my car would be safe to drive.
Every call I made caused me to get more angry.
That’s it.
I’m putting the name of the dealer on my blog and blasting them. Damn them. I’m calling the better business bureau. I’m writing a letter of complaint to the head of the dealership and I’m sending a copy of the letter to the newspaper. How the hell could these IDIOTS risk the lives of my family by just slapping new rotors on my truck without securing them to the wheel hub?
A couple of more phone calls to parts stores that were closed got me even more ticked off. The dealer would probably have to special order the bolts and I wouldn’t be able to drive my truck for a week.
I was fuming.

Then I found a parts store about 25 miles away that might have the bolts in stock. I was in luck. The guy I spoke to put me on hold while the manager of the parts department came to the phone.
“What can I get for you?” he asked.
“I need two sets of bolts that hold the rotors to the wheel hub for an ’04 Chevy Blazer.”
“You mean lug nuts?”
“No. The rotor itself has two threaded holes on it. I’m assuming that bolts go through those holes and attach the rotor to the wheel hub. Right now, when I pull the brake calipers off, the rotor is just flopping around on the wheel hub.”
“Yeah, but it’s supposed to be like that.”
“Are you serious? The rotor is just supposed to flop around on the wheel? What if it slips?”
“Bud, I was a mechanic for 20 years. Once you put the wheel back on and tighten up the lug nuts, the rotor is locked in place. It won’t move a bit. You don’t need the screws to hold the rotor in place. The lug nuts do that.”
“Are you sure?”
“Every mechanic I know has been doing it like that for as long as I can remember. A lot of car companies don’t even make bolts to hold the rotors in place. Besides – sometimes you get rotors that aren’t made by the manufacturer and they don’t even have the holes in them. Sometimes the holes don’t line up with the holes in the wheel hub. Then what do you do?”
“Makes sense. I just don’t want the brakes to go or the wheel to pop off or anything like that.”
“You’ve been driving around on them for how long without a problem?”
“A long time … OK, I get your point. I’ll have to bring you in a six-pack for putting my mind at ease. Thanks.”

I’m sure he hung up the phone and thought to himself “what an idiot.” Even so, I’m making it a point to go to his shop in the future because I value his opinion, and instead of trying to sell me something, he helped me understand the problem.

Then I had a “lightbulb moment.”

What I just went through is exactly what many patients must go through after having a bad outcome from medical treatment.
Patients accumulate knowledge about medical problems from all kinds of sources. Maybe they read things off the internet. Maybe they hear things from neighbors or relatives who had similar problems. But, just like my experiences with my brakes, the information that patients accumulate about their medical treatment isn’t always correct.

I know very little about replacing a rotor, and when something wasn’t the way I expected it to be, I assumed the worst – even though the work was done right. I spoke to several people at auto parts stores who apparently knew as little about replacing rotors as I did. Their uninformed comments got me so mad that I wanted revenge.

My problem was that I assumed I knew enough about brakes and rotors to make a decision about the competency of an expert I hired to fix my truck. When I doubted his competency, I then tried to confirm my suspicions with others whom I assumed knew more about the topic than I did. But I never went to the expert who did the work. In fact, I never asked any expert. I just assumed the worst. Based on my lack of knowledge I was ready to blast an expert who did appropriate work.

When there is a bad medical outcome, or even when there is the perception of a bad medical outcome, the natural tendency is for patients to assume the worst. The patient with the bad outcome then discusses his experience with others, and may be provided with misinformation. Enough misinformation and pretty soon the patient is all worked up – maybe for no reason.

Not saying that bad outcomes never occur from someone doing something wrong – whether talking about car parts or surgical treatment. Just saying to make sure you’re well informed before making that decision.

What did I learn from my experience?
1. Don’t jump to conclusions.
2. Experience is what makes an expert an expert.
3. There would be a lot less acrimony in this world if people would just communicate better.

19 Responses to “Assuming the Worst”

  1. Kim says:

    Unfortunately, my bad outcome experiences are more like if I somehow got the car to the dealer without being able to brake at all, and the dealer told me there isn’t anything wrong with the brakes, I just need to learn to go easy on the radio. So I trust them and continue to creep around with no brakes, and only after having the inevitable wreck do I learn what the problem was. :P

  2. Hank says:

    I think your story also illuminates another problem: how do you know the “expert” knows what they’re talking about? Any of the other supply shops could have told you that the screws you wanted were unnecessary. We face the same thing in medicine: “somedood’s aunt” is a nurse (actually a medical assistant, but what’s the difference to the patient?)…. the local surgeon weighing in on bird flu… etc. And you end up getting misinformation from people who who are “expected” to have some expertise.

    I think there are a lot of patients who trust their doctor less than they trust their mechanic. How do we get that trust back?

    • WhiteCoat says:

      Good point. I would have been at the dealership swinging a baseball bat at someone’s knees by the next morning.
      A pet peeve of mine is when medical “experts” give opinions about issues on which they have little knowledge. Part of our job as the non-expert is not to blindly rely on the expert opinion, but also to examine the bona fides of the person giving the opinion.
      The title “Dr.” doesn’t make one an expert in all branches of medicine.

  3. RTM says:

    Those holes are so that if the rotor freezes/rusts to the hub (a common occurrence because of the rapid heating/cooling on disc brakes), you can thread a matching bolt into the hole and crank it in so you can push the rotor off the hub instead of banging it with a hammer and possibly damaging other parts.

    Great reflection though. That was a very well said analogy.

  4. Max Kennerly says:

    Consider if every parts store or dealer you called said, “I can’t say without you bringing in your car and giving me a week and paying for an inspection.”

    Consider if the only person who could even start to answer your question was the dealer himself, and he either gave you an answer well beyond your comprehension or sternly told you nothing was wrong.

    We have a lot of potential clients come in (medical malpractice and otherwise) and tell us they “just want to know what happened.” More often than not, the answer is: a tragedy, but not an accident.

    Had one of those recently — terrible tragedy involving a minor who died from a treatable, but very rare and hard to diagnose, condition. They, theoretically, could have been saved, but no one picked it up until too late, just the nature of the disease. The doctors gave them an answer that, to them, sounded transparently false, an attempt to explain away a mistake.

    We had our nurses look at it. Paid a doctor to look at it. Then brought the family in and explained in detail everything that happened, and why it wasn’t a mistake.

    And they thanked us sincerely and moved on.

    • WhiteCoat says:

      At the risk of starting an argument, I’m going to disagree with your analogy.
      Commenting on a part is like a medical professional describing side effects of a medication.
      Your example is more along the lines of someone asking “Why does my car make this grinding noise when I drive?”
      The other issue is that my intuition tells me there are few if any multimillion dollar judgment against parts supply shops for giving wrong advice about a part (I’ll freely admit I’m wrong and apologize if you can cite a couple). However, giving erroneous medical advice over the telephone is commonly cited as a liability for medical providers. The standard reply for advice in our ED now is “We can’t give advice over the telephone. If you come here, a doctor would be happy to see you.”
      I agree with your statement about why many people seek out attorneys. I have friends and acquaintances come to me frequently to ask about medical issues that their own doctors will not discuss with them.
      Of course I have them sign a 11 page waiver and disclaimer before I talk to them, but that’s another story.
      ;-)

      • Max Kennerly says:

        I don’t disagree with your medication analogy, that’s what I was trying to convey. From the perspective of the mechanic/doctor, your call to the brake shop is analogous to a patient calling about the expiration date of liquid-suspension omeprazole — beyond the layperson, but simple and easy to answer for the professional. From the perspective of patients, though, your call was analogous to asking a doctor on the phone “did they screw up my angioplasty?” A doctor has good reason to say “I think you should come in.” Unlike brakes, most medical problems can’t be solved on the phone and, worse, most medical problems will never be fully understood by the patients.

        I’m not faulting doctors for this problem, just pointing it out as a difference. For good reason, patients simply can’t get a quick answer when they want a second opinion or to confirm something from another source. It’s a tedious, difficult, often expensive process, one that often leaves patients just as bewildered when they started.

        This problem isn’t unique to medicine, all professions have it; just today I spend a good deal of time talking a client out of their belief that the judge in the case (who I’ve known for years as being very fair) was biased against them because so-and-so’s relative works in the courthouse.

        I don’t have a brilliant solution to this problem, nor do I think it dampens the core point of your fine post, just pointing it out as different.

  5. ER RN says:

    “1. Don’t jump to conclusions.
    2. Experience is what makes an expert an expert.
    3. There would be a lot less acrimony in this
    world if people would just communicate better.”
    4. You dont need bolts to hold your brake
    rotors on…LOL

  6. rlbates says:

    I love this post! Communication is undervalued. I continue to try to improve in that area.

  7. k says:

    Patients need to assume responsibility for educating themselves (Wikipedia and self-diagnosis at the Google University don’t count) so they can communicate more effectively with their physicians. Communication is a two-way street.

    Been hearing radio ads about questions to ask your doctor. (It might be pretty hard for a pt coming in to an ED with an MI or stroke to ask a bunch of questions, though.)
    Much of the material on that page (and in links that branch from it) seems relatively obvious/generic.

    Any opinions on this page as a starting point for patient education to improve communication and lessen misunderstanding?

    Some of the “Effective Health Care” brochures look pretty good. They seem well-written and factual (evidence-based), without being dumbed down/condescending. This part of the site seems most geared to Medicare patients and their conditions – it would be nice to see info for asthmatics, hypo/hyperthyroidism, generic drugs, etc.

  8. Amen to lesson learned #3. My employer would be more successful in all aspects of the company if they spent as much effort on proper communication as they do in budget meetings….

  9. Chrys says:

    I loved this post too. What an excellent analogy.

  10. I don’t find myself in the chorus all too often but I certainly agree with the majority of commentators here, WC: this post was damn fine and an excellent example of the need to pay attention to the mind.

    Yum.

  11. SeaSpray says:

    I agree.

    This was a terrific post WC! :)

  12. Okay, I’ll sing off-key! This post felt like condescension of the highest order. The rhetoric about “experts”? An adroit rhetorical bait-and-switch. I gagged on the persuasion.

    All things being even, including divergent “expert” opinions? Never substitute someone else’s judgment for your own. Yes, with the obvious provisos of respect (not deference) and openmindedness (again, not deference).

    All that patting on the head has messed up my hair, harumph.

    I know I’ll love the next one.

  13. Not to hog the comment section — but with my first cup of coffee, I read this op-ed and the assessment of “experts” fairly leapt off the page!
    http://www.nytimes.com/2009/03/26/opinion/26Kristof.html?_r=1&em

  14. [...] Coat uses his experience from another part of life to illustrate that sometimes patients get it wrong. What appears to be an error is not always an [...]

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