Comments on: Assuming the Worst http://www.epmonthly.com/whitecoat/2009/03/assuming-the-worst/ A blog from inside the emergency department Wed, 08 Feb 2012 14:07:09 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Grand Rounds — When things go awry | Hospital Health Care http://www.epmonthly.com/whitecoat/2009/03/assuming-the-worst/#comment-7661 Grand Rounds — When things go awry | Hospital Health Care Tue, 31 Mar 2009 23:00:45 +0000 http://www.epmonthly.com/whitecoat/?p=2262#comment-7661 [...] 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 [...] [...] 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 [...]

]]> By: Bianca Castafiore http://www.epmonthly.com/whitecoat/2009/03/assuming-the-worst/#comment-7581 Bianca Castafiore Fri, 27 Mar 2009 13:03:00 +0000 http://www.epmonthly.com/whitecoat/?p=2262#comment-7581 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 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

]]> By: Bianca Castafiore http://www.epmonthly.com/whitecoat/2009/03/assuming-the-worst/#comment-7573 Bianca Castafiore Fri, 27 Mar 2009 03:35:25 +0000 http://www.epmonthly.com/whitecoat/?p=2262#comment-7573 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. 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.

]]> By: Max Kennerly http://www.epmonthly.com/whitecoat/2009/03/assuming-the-worst/#comment-7552 Max Kennerly Thu, 26 Mar 2009 02:31:10 +0000 http://www.epmonthly.com/whitecoat/?p=2262#comment-7552 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. 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.

]]> By: SeaSpray http://www.epmonthly.com/whitecoat/2009/03/assuming-the-worst/#comment-7550 SeaSpray Thu, 26 Mar 2009 00:44:05 +0000 http://www.epmonthly.com/whitecoat/?p=2262#comment-7550 I agree. This was a terrific post WC! :) I agree.

This was a terrific post WC! :)

]]> By: WhiteCoat http://www.epmonthly.com/whitecoat/2009/03/assuming-the-worst/#comment-7547 WhiteCoat Wed, 25 Mar 2009 21:48:21 +0000 http://www.epmonthly.com/whitecoat/?p=2262#comment-7547 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. ;-) 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.
;-)

]]> By: WhiteCoat http://www.epmonthly.com/whitecoat/2009/03/assuming-the-worst/#comment-7546 WhiteCoat Wed, 25 Mar 2009 21:37:18 +0000 http://www.epmonthly.com/whitecoat/?p=2262#comment-7546 See - I'm learning more about trucks every day! Thanks! See – I’m learning more about trucks every day! Thanks!

]]> By: WhiteCoat http://www.epmonthly.com/whitecoat/2009/03/assuming-the-worst/#comment-7545 WhiteCoat Wed, 25 Mar 2009 21:36:38 +0000 http://www.epmonthly.com/whitecoat/?p=2262#comment-7545 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. 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.

]]> By: WhiteCoat http://www.epmonthly.com/whitecoat/2009/03/assuming-the-worst/#comment-7542 WhiteCoat Wed, 25 Mar 2009 19:42:03 +0000 http://www.epmonthly.com/whitecoat/?p=2262#comment-7542 Dang. Wish I had thought of that one ... Dang. Wish I had thought of that one …

]]> By: the psycho therapist http://www.epmonthly.com/whitecoat/2009/03/assuming-the-worst/#comment-7535 the psycho therapist Wed, 25 Mar 2009 12:19:59 +0000 http://www.epmonthly.com/whitecoat/?p=2262#comment-7535 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. 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.

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