Tuesday, December 13, 2005

Dr. Know-It-All

One of the things I love most about being a doctor is knowing things. One of the most important things one learns in medical training is how to "interpret the literature" — how to find studies that apply to a clinical question and then how to tell if a given study is any good (a surprising number of them aren't, or are only useful in a very limited way).

I also love sharing my knowledge. I've never been annoyed by friends and family members who ask me medical questions. Since I'm an internist, a lot of the things they ask are the same things I manage every day with my patients. And I'm very comfortable admitting when I don't know something.

But I don't want to become little Dr. Know-It-All. Sometimes when roaming around in the blogosphere, I come across descriptions of medical issues that seem either wildly inaccurate or possibly mismanaged, and I have to sit on my hands to not comment. For instance, I came across a mention of someone being treated for years with intramuscular antibiotics for "chronic Lyme disease." Although I know that this is essentially malpractice, it's none of my business, and I'm sure the comments of an anonymous stranger aren't going to change things anyway. But I hate thinking that someone else reading it will be misled.

There are a lot of murky areas in medical knowledge, and I enjoy reading educated debates about these issues. So much of what we once "knew" to be true has turned out to be wrong, wrong, wrong. Humility is a critical attribute for a clinician. But so is confidence, and it's a difficult balance to strike sometimes.


Anonymous said...

I imagine it is hard to keep quiet sometimes. My problem with my doctor friends/acquaintances is that I feel strange asking them for advice. I don't normally like to talk about my job outside of work, so I assume they don't either. I bet you've had people ask you some pretty strange things outside of clinical settings.

Mignon said...

Yes, ditto what tb said. I even avoided seeing a very close friend for a shoulder issue so that she wouldn't think I was using her. I ended up hurting her feelings. She expressed the same sentiment as you and really understood. If you are a doctor because you want to help people, why would that desire end at 5:00?

Last night I was talking to my friend's husband. He owns a computer sales and repair business and I ventured that computer fixers and doctors are two professions that will constantly prompt complete strangers to say, "I have this problem..." Actually I was sorry I said that, because I did have a problem I wanted to ask about and I shot myself in the foot.

Orange said...

What's your take on Flovent for moderate asthma? Here's the deal. Lately, I've been noticing that...

(Just kidding. I have a good internist of my own.)

[My word verification entry is xxvbogal. I'm an XX v-bo kind of gal!]

Anonymous said...

Bwah ha ha yeah I've got about thirty sick kid questions for you while we're on the subject...not! Although it's not even remotely the same thing, I often find errors in grammar in menus, corporate newsletters, etc., and am tempted to point them out, but then don't want to be that obnoxious smarty-pants professor person. But for the record, if you ever come across anything the various doctors are doing to my kids on MFA Mama, I wouldn't hold it against you if you said something. And if you ever make a grammatical error on Dr. Mama...well, I'll just keep that to myself and gloat, because I make them often on the blog (part of the fun of the blog is not HAVING to be a paragon of grammatical virtue for once) and your editing skills are usually better than mine!

nancy said...

My sister-in-law, who is a lovely person who I am oh-so-glad is my SIL (seriously), is an MD and HATES being asked anything medical. When you do ask you usually get a very cryptic answer, something that makes it clear that she does not want to answer your question.

I am a lawyer and also get people asking me legal questions. While I don’t mind at all, I generally don’t know the answer. My practice is limited to certain areas, and generally the questions people ask over dinner are not in those areas. So, if you need to know about the Graham-Leach-Bailey Privacy Act, I’m your person. If your soon to be X is a pig and you want some divorce advice, I’ve got nothin’.

Anonymous said...

Because so many of my family and friends are doctors and nurses I'm comfortable asking them lots of questions. Mostly because I'm just curious, and questions are encouraged in my family.

On a road trip through the Middle-of-Nowhere, Wyoming many years ago I began to experience alarmingly acute (to me, the wimp) chest pain. I used a payphone to call my mom (nurse) on the West Coast during a dinner party, described my symptoms only to have her hand the phone to her friend (dermatologist). She deduced that I was experiencing costochondritis, and that ibuprofen would probably make me feel better. It did. I was never so grateful for you know-it-all types. :)

Also many years ago, I related the details of a friend's mystery illness, rapid decline and frightening death to my grandfather and aunt (pulmonary internist and pathologist). I told them that several autopsies had revealed nothing.* I was surprised to hear them both say, calmly and a bit sadly, that sometimes people die and we don't know why.

I love that you know so very, very much that is so incredibly helpful to so many. And I respect that there is a limit to what is known both collectively and individually.

You sound like a great doctor, incidentally. :-)

PS - What do you think of Doctor/Senator Bill Frist?

*Eventually, a tentative diagnosis of Hantavirus was reached.

thumbscre.ws said...

Wow, that's refreshing to hear... as a compu-geek, I'm constantly hearing coworkers grumble about being asked to fix people's PCs when they're off-duty. Guess I just assumed that other professionals felt similarly. As for myself, I like bartering... I work for lawyers, and I'm more than happy to virus-clean their home PCs in exchange for the occasional piece of off-the-record legal advice (turns out that the state of Nevada court system would NOT condone shooting a man in Vegas just to watch him die). I got to make me some doctor friends... I'd be willing to set up a wireless network or two in order to learn why the baby and I have had nasty, phlegmy coughs for two weeks.

DoctorMama said...

"I bet you've had people ask you some pretty strange things outside of clinical settings"
Actually much stranger in the clinical setting.

xx v-bo gal: Flovent for moderate asthma? Outrageous malpractice! (also just kidding.)

MFA Mama ... you probably know more pediatrics than I do at this point.

nancy -- that reminds me of a friend of mine who was a lawyer and was asked for advice about several things by her hairdresser (probably about a pig ex) and when she explained that she didn't know anything about the subjects, the hairdresser paused and finally said, "I guess there's all kinds of law, huh?"

re: Bill Frist -- the first thing I ever heard about him was when I was talking with a cardiothoracic surgeon who had worked with him who said, "It was a good day for patients when Frist became a politician" -- I guess he didn't have the best reputation as a surgeon. But he completely lost my respect when he got involved in the ghoulish Terry Schiavo freak show.

thumbscre.ws -- you'd be making a poor bargain re: setting up networks, because no matter what they say, NOBODY can really explain why you and the baby are coughing. But we know that the antibiotics we have right now won't fix it. Anyway I do macs, so the virus thing doesn't tempt me to make some shit up.

DoctorMama said...

P.S., thumbscre.ws -- I could give you some nosebleed management pointers if you want!

thumbscre.ws said...

Re: cough. Nobody can explain it? That actually makes me feel much better! I was guiltily assuming it was because I wasn't running the humidifier every night (my nurse-practitioner seems to think the humidifier can fix everything from congestion to cracks in the fascia of the space shuttle, but the hissing sound keeps J.Q. awake).

Actual M.D. nosebleed management tips would be MOST appreciated! I got very conflicting advice from those at work (tip head back, tip head forward, pinch nose, go expel big bloody clot of snot on attorney's desk, etc.).

panamenya said...

I don't know if I've commented on your blog before or not, but after this post it seemed appropriate.

Have you written about vaccines yet? What is your stance? Are they all necessary? Do the benefits outweigh the risks in every case?

All my doctor friends thus far have been unwaveringly pro-vaccine, but their dogma makes me disinclined to listen.

Conversely, the granola tree huggers who claim all vaccines are instruments of Satan turn me off as well.

It's kind of like the abortion issue: both sides are replete with fever-pitch adamance and I feel like I'm not actually hearing the truth from either.

You seem reasonable. What's your take?

thumbscre.ws said...

I'd be really interested to hear your take, too. I'm pretty pro-vacc myself (as my parents knew plenty of kids when they were younger who were killed/harmed by what later became preventable illnesses), but every now and again the anti-vacc folks toss out an argument well-reasoned enough to scare me a bit.

I'm a mom, though. Everything scares me. In addition to the "Why It May Not Be a Good Idea to Shake Baby" brochure (we actually got that one at the hospital, and had a tired chortle over it), they should give new parents one entitled "Welcome to White-Knuckle Terrorsville, Population: You".

A said...

Yeah, I know the feeling. I'm not a doctor, but I do have a master's in public health and I run a maternal and child health project. Sometimes I have to take a deep breath and shut down the computer when I read the things people say about childbirth and breastfeeding...

Sara said...

You're an internist, not an FP? Whoa! All this time...I just assumed.