Tuesday, 26 June 2012

Stupid questions

"The only stupid question is the one unasked." - DocBastard

Ok, I have to admit I didn't actually say that first, and despite exhaustive research (i.e. a 10 second Google search), I have been woefully unable to figure out who did say that first.  However, after thinking about it for a while, I realised that I am damned glad I didn't say it, because it's entirely untrue.  There are plenty of stupid questions that actually get asked.  I get asked these stupid questions all the time - mostly by patients, but also by their families, nurses, and even other doctors.

I get this one all the time: "Is my leg broken or fractured?"  Uh...what?  I wasn't aware there was a difference.  I must have missed that day in Bones 101.  If your bone isn't in one piece, it is broken.  Full stop.  If you're asking if you need surgery to fix it, well that's a different question.

"Is this laceration across my face going to leave a scar?"  No, some brilliant surgeon invented a way to reroute the entire wound healing process.  OF COURSE it's going to leave a scar!

One thing that car accident victims love to ask is, "How can I get my wallet/purse/money/gun from my car?"  They also love asking the details of the accident.  Sorry genius, but I wasn't there.  I can't begin to guess how your car ended up in a ditch, and I haven't the foggiest idea who has your cell phone.

"When is Dr. Consultant going to be here to see me today?"  I love this one.  I work with dozens of doctors at several hospitals, and I can personally guarantee you that I don't know the daily schedule of a single one of them.

I guess that idiom needs to be changed.  I'll propose this alternative: The only stupid question is the one you ask without using your brain first.

EDIT: I will confess that I deleted two questions from my post that, after reading a few comments, I decided aren't stupid at all.  Rather, they just put us in an impossible position to answer.  "How long will I live" and "How long will I be in the hospital" are very difficult to answer, but very understandable to ask.  I'm guilty of some stupidity sometimes too, and I apologise if I upset anyone too much.

13 comments:

  1. How long do I have to live relates to the average that people live with this disease. Everyone knows that you are guessing, but your guess is more educated than ours.

    Is my leg just fractured or cracked means "Is my leg broken in half, or does it just have a crack in it?" Probably not a substantial difference, but we want to know what is going on with our bodies.

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    1. I agree with both of these. As a layman I don't find either of them unreasonable questions. Also the how-do-I-get-my- question strikes me as reasonable (although more for the ER doc)--you deal with a lot of patients in accidents, you very well might know what we are supposed to do. You're not the ideal person to ask but we don't have an ideal person to ask.

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  2. "The only stupid question is the one unasked" is kind of true. Usually stupid questions come from stupid people right? Now I'm not saying that someone who asks a stupid question is stupid, but rather that stupid people ask stupid questions without realizing that it's a stupid question. What we find stupid may be an average question to them, and a question that they find stupid and don't want to ask may be an extremely stupid question to us. Get what I'm saying?


    Gosh, I hope I don't confuse anyone.

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  3. when i was 7, my dad was diagnosed with a non-hodgkins lymphoma and told he had about three years to live. he died when i was 23, so yes, he outlived the doctor's estimation by many years. i'm still glad the doctor told him, and my dad told me, because it taught me very early on to cherish every day i got to spend with him.
    when he died, it still was hard on me and hurled me into a depression (it was only the last straw, the real reasons where others), but i was still in peace with it. after all, i've had most of my life to mentally prepare for it, and i had made a point of telling him i loved him every time i talked to him.

    so, no, that question is NOT stupid, everyone who asks you knows you are just making an educated guess, but it helps your patients and their relatives to deal with what is inevitable after learning that they are terminally ill.

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    1. As I said, it's entirely understandable to ask this question, but it puts us in an impossible situation as you've beautifully illustrated. If you had been told he had 3 years to live but he died 2 months later, imagine how you'd feel about the doctor.

      Not everyone understands that's an educated guess, unfortunately. But I see your point.

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    2. Well, i have no idea about how i would have reacted at age 7. from my knowledge about statistics i have now, i know better than to blame the doc, who is doing his best to help, for life refusing to play nice.

      But then, thinking about how my mom is handling situations like that i can see her sitting in the doctor's office, repeating "But you said he had THREE YEARS!" over and over. so i can see why you say it's an impossible situation.

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    3. When my grandmother was in hospital for the first 3 days the doctors and nurses were rushing about and taking her away for tests etc but didn't tell us anything. While I understand they had to do it and didn't want us interfering, I would have appreciated any information they could have given us. Eventually they said she had pancreatic cancer plus a bleeding spleen that they couldn't do anything about and that she didn't have that long left, maybe months or weeks. She passed away 3 days later. We were not prepared in any way, it might have been a bit easier if our questions were answered.

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  4. I must say that I find some of those entirely understandable in the circumstances.

    I'm sure that someone asking how long they have or how long they will be in hospital is not really asking for the exact date but for an educated estimate. Very few people have a feeling for how major a piece of surgery is or how severe and illness, where as you will see many of them every month. I can guess that it will take longer to recover from a liver transplant than from a appendectomy but that's about as far as it goes. You, on the other hand, are likely to be able to say "typically around x weeks" or "at least y days". They could ask "on a statistical basis what is the expected hospitalisation period for a procedure of the type I am undergoing?" but that would just be wasting everyone's time.

    Patients do have lives to lead too. Their employers will be asking them when they will be back at work and their partners/kids will be asking when they are coming home. The answer "I don't know, the doc said I'd have to wait and see" is just unnecessarily unhelpful when "3 to 4 weeks if there are no complications" at least sets a minimum that they can work with.

    I had the unenviable task of attending the meeting with my little brother (well, I say little - he was 30) when he received a terminal diagnosis. He asked his prognosis, and his consultant said something like "Without treatment we'd be looking at a few weeks but we'll try x & y to control it." I cannot believe that it's unfair to ask that and the consultant did his best to answer. He was an oncologist and so a predictably large proportion of this patients are going to die of what he is being consulted on so he has to expect that. They need to get what value they can out of the time that they have and a little information helps them enormously with that. A big part of what the doctor brings to such situations is his experience with conditions that patients meet (almost by definition) no more than once in a lifetime. It is not unreasonable to ask for an opinion and nobody expects it to be more than that.

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    1. I'm obviously not articulating this well. Of course it's normal to ask how long you'll be in the hospital, but I was mainly referring to people who are shot in the arm, leg, abdomen, and chest and have multiple procedures done by multiple surgeons. And as I said, it's normal to ask how long you'll live after being given a terminal diagnosis. It just puts us in an impossible situation, and all we can do is give statistics.

      I clearly stuck my foot in my mouth on this one.

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    2. I can see that it's difficult for you to answer such questions because obviously you can only give an opinion based on stats and your own experience. However it's far more difficult for a patient to make that judgment.

      Evidently it's stupid to expect that you will be able to predict details of an individual case. Perhaps more people think you can do that than I imagine. Nobody should be surprised if things pan out a little differently from the plan because if we were robots with exact specifications and modes of failure we would not need doctors but mechanics.

      The situation of multiple procedures is an interesting one because presumably more will be discovered as the treatment progresses. All anyone can do is work with the information to hand.

      For every patient who outlives his/her prognosis or goes earlier than expected there will be a much larger number that have about as long as anticipated. My brother's "few weeks" turned out to be about six.

      It is difficult to give advice knowing that sometimes you will be wrong. That does not stop the advice being valuable, however, or make it wrong to give it.

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  5. Hey Doc!

    Hope I didn't come across as upset by your post - that was not my intention. Obviously I remain upset by some of the background - you don't lose your only sibling at the age of 31 and walk away unscathed - but that's not your doing.

    I do think it's easy to forget when you have trained for so long and have been immersed in a specialism so thoroughly, that most people do not know what seems so obvious to you. They don't know the technical stuff but they also don't know the system. That tends to make them ask ignorant questions which are by their nature easy to confuse with stupid questions. I'm sure I am not immune from doing the same.

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  6. First off all, I want to congratulate you on graduating medical school, and following on to be a general surgeon. However, I am at unease with your attitude towards your fellow coworkers and patients. But the fact of the matter is that most people are less intelligent than their doctor. It is natural for one to be curious about their bodily healthy. Any legitimately curious question is not stupid as it provides a learning experience. As a teacher answering so called "stupid questions" is what we do for a living.

    Also, I've seen you comment on FML numerous times. It is what led me to your blog.

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    1. I have the utmost respect for the vast majority of people, and I make that known to them liberally. I always treat my patients with respect unless they've done something stupid. I have no qualms about telling someone that their actions are stupid, and the patients usually agree with me. But I've never told a patient that he or she IS stupid, only their actions.

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