Monday, 10 June 2013

Let me do my job

Even though I've been driving for several decades, I will confess that I barely have a clue about how an internal combustion engine works.  I know that there are pistons that move in cylinders due to contained explosions of gasoline caused by a spark plug, and there is a lot of other, uh, stuff in there, and...well, that's about it.  So whenever I have car problems, I take it to a mechanic.  He's an expert and knows how this complicated machine works, while I just don't.  If he tells me that I have a problem with a caliper, pump, gasket, belt, or flux capacitor, I have little choice but to believe him.  I'm not saying I'll trust everything he says implicitly - if I have any doubt, I'll call a second opinion (my brother, who has literally disassembled and reassembled several engines), and if he and I think the mechanic is taking me for a ride (pun intended), I'll find a different guy.  But if it's legitimate (and it invariably is), I keep my mouth shut, whip out my credit card, and wonder how many of the mechanic's mortgage payments I'll be making this time.

"Is this really a post about cars?  I didn't come here to read about your damned car troubles, Doc!"

Fine, I'll get to the point.  It's not my fault you're so impatient.  Anyway, if you think a car engine is complicated, it's a cakewalk compared to the human body.  See, I told you I'd get to the point.  I know how the human body works and what makes things go wrong, and the vast majority of people don't.

So why do so many people question me?

Several months back I took care of a young man who was involved in a serious car accident involving speed, youth, alcohol, and a dash of stupidity.  His only serious injury was a very small bruise in his brain which was immediately diagnosed with a CT scan.  I repeated his brain CT the next day, and it looked completely stable with no signs of worsening.  The treatment for this type of injury is time and physical therapy, and most people recover fully, spending only a few days in the hospital.  Initially he could barely talk, but after a few days he started doing much better; he was talking, eating, and walking, and he looked about ready to go home.

That's when I got the inevitable irate call from Doctor Mom.  She had apparently heard of my plans to send him home in a day or two, and as soon as I said "Hello" (at 10 PM, no less), she launched into her enraged verbal assault.

"HOW CAN YOU BE SENDING MY SON HOME?  YOU HAVEN'T EVEN DONE AN MRI!  HOW DO YOU KNOW HE'S NOT BLEEDING IN HIS BRAIN!"

I very calmly tried to explain that his repeat scan was stable and he was doing much better, and that is how I knew there wasn't any further bleeding.  She immediately calmed down, thanked me, and said...oh, who am I kidding?  My rational thinking did absolutely nothing to calm this irrationally crazed woman, who relentlessly continued her attack.

"WHY HAVEN'T YOU DONE AN MRI?  YOU DON'T KNOW HE ISN'T BLEEDING BECAUSE YOU HAVEN'T LOOKED!  HE NEEDS AN MRI!  HOW LONG HAVE YOU BEEN A DOCTOR??"

My wife unfortunately overheard her enraged ramblings, and I nearly had to restrain her from grabbing my phone and yelling at her and calling her a lunatic.  I again calmly explained that an expensive MRI wasn't necessary, because clinically he was doing fine.  And even if I had suspected anything wrong, which I didn't, a CT scan would be a much better, faster, and less expensive test.  But even if I ordered an MRI and even if it showed a bruise, it wouldn't change my care plan one bit because clinically he was doing so well, so why even order it?

"I CAN'T BELIEVE YOU HAVEN'T ORDERED AN MRI!"

You get the point.  This back and forth continued for over 20 minutes, with me calm and rational, her...not so much.  I continually had to resist the urge to ask her where she went to medical school and did her trauma training.  Finally, unsatisfied, she let me and my wife go to sleep.  Shockingly, her son was doing even better the next day, and I sent him home, right on schedule.  He did NOT get an MRI.

I would never dream of questioning how tight my mechanic is tightening the bolts on my car's engine or what type of wrench he uses, or if he installed my serpentine belt correctly.  At some point I have to realise that this person knows a lot more than I, so I just need to shut the hell up and let the expert to his job.  So if you have questions, please ask.  But then after I explain things satisfactorily, unless you happen to be a trauma surgeon, shut the hell up and let me do my job.

14 comments:

  1. Doc, I think people feel as though they need to do this sort of thing to doctors, surgeons, and trauma specialists because they have a very basic understanding of how the body works. By no means are they specialists but they think they are. When you have a small amount of knowledge on illnesses and procedures that "fix" said illnesses you want to exhibit your so-called "knowledge". Most people only "know" what they do because of the ever-growing popularity of medical mystery shows. I have a family member by marriage that is a surgeon and he is constantly complaining about patients and their family members that believe they know more than he.

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  2. While i agree with your point i have had my son discharged from hospital because a doctor said he was fine (against my wishes) and he was readmitted after he worsened again and was kept in for two days with the flu. My sis nearly died from meningitus due to a doc believinh his diagnoses so much that he would not listen to us.
    Thankfully these were isolated incidents. While we should trust docs becuase they are the experts they are also human and we shouldnt just take info as gospel. Asking questions as you suggested is the best solution but some docs hate that and will shoot you down.

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    1. When you have real, sensible doubts, that's when you call in for a second opinion. The point was that you don't consider YOURSELF as a second opinion if you're not an expert at .

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    2. My #1 second opinion is google.

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    3. Go back in DocBastard's earlier posts and you'll find something about how much he hates Google pseudo-doctors.

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    4. True, but if Google said something that completely contradicted the doctor then I'd keep moving to other sources. If I don't find any sources supporting the expert at all, then we have a problem.

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  3. How do you not snap at these people?!

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  4. I think my twin would've preferred a post about cars. =P

    Also, my dad told me a friend of his stuck a coke bottle into his rectum once. He had to leave town because it was so embarrassing. Not like leave town to get treated. He left forever, nobody around here knows where he went.

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    1. Oh, also, when would you use an MRI instead of a CT scan? It seems like you don't use MRIs very much.

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    2. MRI isn't used on the brain much in trauma situations unless we're looking for something like a diffuse axonal injury. That wouldn't show up on a CT, but it would on an MRI.

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  5. "Anyway, if you think a car engine is complicated, it's a cakewalk compared to the human body."

    TRUTH. Doc, just wanted to say I have so much respect for people like you.
    I can only imagine the pressure (no matter how experienced on is) of trauma surgeries where one wrong nick could kill or paralyze the patient... Sadly, I'm struggling to understand and carefully work with my cadaver. Well, enough procrastinating for the night, onward to my last round of review!

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  6. You're one of the good ones, but if I had a nickel for every time I've had to fight to keep a resident from doing something stupid to my medically-complex daughter, I'd be a rich man; lack of specific knowledge doesn't mean that a layperson can't call shenanigans when an explanation is contradictory or illogical.

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    1. You are absolutely right. But you're talking ripe apples vs. apple blossoms. Doctors-in-training need close supervision.

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