Wednesday, September 19, 2007

Dear Aunt Bubandpie

Dear Aunt Bubandpie:
I am a doctor – a specialist, in fact – and I’m concerned that my patients have insufficient respect for my authority. What can I do to put uppity patients in their place?
Doctor World-Renowned Expert

Dear Doctor World-Renowned Expert:
You ask a very good question. In this age of Internet access, many physicians are faced with arrogant patients who believe that an hour of browsing on Google qualifies them to offer an educated opinion about their disorders or those of their children. The honour of the medical profession is contingent upon our ability to convey to these parents a sense of their presumption and ignorance.

A common mistake many doctors make is to display their superior knowledge by sharing it with patients. While this may make a good first impression – especially if you are careful to use plenty of polysyllabic medical terms – ultimately this tactic defeats the purpose. The knowledge you share with your patients will serve only to narrow the gap between your expertise and their lowly ignorance. The best way to avoid such a scenario is to follow this simple maxim: Ask questions. Reveal nothing.

Of course, asking questions carries a risk as well. Patients may develop an overly exalted sense of their own importance. It’s essential to use at least one of the following tactics to ensure that patients come away with a sense of confusion and inadequacy. When a patient answers a question, do one or more of the following:

  • Raise your eyebrows skeptically and grunt non-committally. Remember that your goal here is not to suggest that the information provided by the patient is worrisome but rather that it is exaggerated, unimportant, or delusional.
  • Respond with a sentence beginning with the word “But.” The rest of the sentence doesn’t matter – the patient will be on the defensive and unable to absorb what you’re saying anyway.
  • Ask follow-up questions the patient is not in a position to answer. Since you are a specialist, a good approach would be to focus on making the patient account for the motives of the referring agency.
  • Shrug your shoulders frequently – not in ignorance, of course, but rather to belittle the answers your patients provide.
  • Nip in the bud any attempt the patient makes to turn the tables by asking questions of you. A curt “I can’t answer that” will usually do the trick.

These tactics should ensure that your patients leave your office with a strong sense of their inferior position in the doctor-patient hierarchy. Do not cloud the issue with any complimentary or reassuring remarks. Before long, you will begin to see a newly respectful demeanour in place of the brash overconfidence that has become all too common in these degenerate days.

Yours in doctoral solidarity,
Aunt Bubandpie


A Whole Lot of Nothing said...

Trust your gut. Do your own research. Know your child. Never give up.
As a mom, we MUST trust ourselves to know we know best for our child. My daughter has a syndrome that would have never been diagnosed, but because I did my own research, I now know why she is the way she is and how to help her.

Great post!

mek said...

Oh good Lord, this post gave me almost as big a case of anxiety as an actual trip to the doctor would! This plus the previous post...I hope something good comes out of the evaluation despite the not-so-good experience. And I hope somewhere along the way a more generous health professional shows up to help you!

slouching mom said...

Phooey to him.

bubandpie said...

What's going on here isn't even that I think Bub has autism and the doctor doesn't. Because (a) I don't know what I think, and (b) the doctor won't tell me what he thinks.

It's more that there are ways to go about the conversation we had yesterday that wouldn't have left me feeling humiliated and more in the dark than ever.

Kimberly said...

ooooh. Now I'm hopping mad. I'd seriously like to storm this guy's office and take a piece of him for you.

Whole lot of nothing is right, and I also speak from experience. Zen Baby would have died if the experts had been granted their superiority. I say turn the tables anyway--the way I did it was having a very candid chat with the exalted specialist in which I made it clear exactly how I expected to be treated--and not talked down to or patronized where high on the list.

Take your anger and use it to fuel your pursuit for the best life possible for Bub. Show this jerk, and all his brethren, what happens when you patronize and belittle a strong, intelligent mother.


Blog Antagonist said...

Don't give up. There are some awful practitioners and clinicians out there, and I think I have encoutnered at least 50% in the course of diagnosing and treating two children with learning/emotional disabilities.

But keep looking. The good guys are out there, and they are worth their weight in gold. Get referrals from other parents, your physician, your green grocer. Word of mouth is your friend. If someone is raving about how awesome their therapist is, beat them until they divulge contact information.

In desperation, I picked DO's latest (in a long string) of therapists from our provider listing and she turned out to the most wonderful person. I give out her business cards like candy.

Good luck. I know its disheartening and frustrating. God, how I know.

Listen...I have a friend whose six year old son, has autism and she is a FOUNT of knowledge about how to navigate the system and how to avail yourself of the resources available. If you're willing and she's willing (I'm pretty sure she will be) I can hook you guys up.

Email me.

Bon said...

erm, great strategies.

that much fun, huh? so sorry, B&P. i really hate being made to feel minimized and dismissed and humiliated all at the same...and you're right, there's no need for that. you're not there to push a particular agenda about your child - you're there to seek help in finding answers.

Jenifer said...

It took two trips to Emergency to convince the doctors that Rosebud was seriously ill, despite the fact that she was limp in my arms and burning up. We were sent home the first time and not exactly greeted nicely the second. Turns out the test results were misread and she had huge infection the FIRST time and the doctor made a mistake and sent us home.

The doctor we saw on our second visit - after waiting seven hours for various blood and urine (with a catheter) samples to come back to lab, literally offered a shrug as to why we were sent home the day before and why the tests were misread. No apology, no sorry you spent two full days in Emergency and most importantly no sorry she suffered an extra day for no reason. Nothing at all.

At the time I was so exhausted I couldn't even respond properly. I did however send a letter to the hospital after.

Never, ever doubt your instincts. Whether Bub has autism or not, or on what end of the scale is not even the point. You know something is amiss and you just want to know the best way to help him reach his full potential.

Kyla said...

Do you have options regarding these arrangements? Could you be referred to someone else?

We have a really great team of as informative, kind, honest...and without them I would lose my freaking mind. No one leaves me in the dark, if they did, I'd lose my sh!t. We've had a doctor or two that did, and our ped recommended replacing them and I am so happy with the decision to do so. My ped calls me with information to look up in online medical journals and points me to reliable sources...she knows that it is just as important for me for me to be informed about what they are thinking as it is for them to be informed about what I am thinking.

You are an important part of Bub's team, probably the MOST important part, because you know him best. You shouldn't be in the dark.

m said...

Any clever person can blind you with science. It takes a true expert to make the complex accessible to the rest of us, without being patronizing.

nomotherearth said...

I know how frustrating it can be to deal with "specialists". They can make you feel ridiculous just for being there "wasting their time", even if it wasn't your idea to be there in the first place. Hang in there. And, like everyone else says, trust your instincts and keep pushing till you get what you need. (I know - Easy to say, but hard to do..)

cinnamon gurl said...

Way to irony as a coping mechanism! This post both cracked me up and made me very sad.

mr. b&p said...

To be fair, I wasn't all that put out by Dr. WRE's manner and conduct. An expert's prelimiary feelings can too easily be taken for a expert opinion, so I expected nothing other than general caginess at this point.

Depending on one's standpoint, downplaying concerns could be seen as an effort to allay fears of a dreaded "autism diagnosis" rather than being dismissive.

I think it's fairly clear that what little feedback we received wasn't really helpful and that he may have read us wrong, but it's a bit extreme to paint the doc as an arrogant asshole who wanted to make us feel like idiots.

Maybe he is. I think we'll need at least another session before that call can be made though.

NotSoSage said...

Oh, don't even get me started. We should get together and swap stories some time...I've actually written a letter of complaint to an institution based on this kind of treatment. And was essentially given the same treatment right back. Yay!

But Mr B&P's comments are interesting...I hope that a second or third round will increase your confidence in this guy...

Thinking of you.

bubandpie said...

Yeah. I don't think he was trying to make us feel like idiots - but I felt like one anyway.

And yes, we could be referred elsewhere - if we want to wait another 18 months to get to the top of the waiting list.

I don't really think that Dr. WRE is a jerk who must be kept far away from my son - in many ways he's a friendly, affable guy. But I'm sore and I'm tired and I need to put my anger somewhere, so it's winding up here.

Mimi said...

How did I miss so much the last couple of days?

I think you ought to forward a copy of this to the doctor.

I know how you feel about this kind of interaction: it is particularly enraging to be a competent, literate, intelligent person, and to feel yourself shrinking in this way, all the while you're conscious of precisely how it operates, but unable to make it stop.


Patois said...

In the end, it's how you feel about the encounter. And if you can't vent here, where the hell can you vent? I'm sorry you walked away feeling that way.

Casdok said...

Remeber you know best.

painted maypole said...

i get the exaggeration part of this post, but it's frustrating all the same. it does sometimes feel like they are schooled in these things, doesn't it?

natalie said...

Brilliant analysis. I think the cliche is that doctors are often socially clueless or so wrapped up in "reason" and "logic" that they forget how to deal with their patients' emotional needs. That may sometimes be the case, but I think it's also true that many doctors have, as you so deftly point out, become experts in maintaining the power and prestige of their profession by making us feel small. What's really fantastic is that you see through it and, though the doctor's behaviour may be infuriating, it cannot be successful in cowing you. Bravo.

Christine said...

can i send a copy of this to every doctor i know.

i hate arrogant mds.

AnneK said...

This post so resonated with me. Oh these doctors. They are past masters/mistresses at the art of condescension. How I hate going to the doctors! Making you look like a fool and humiliating you just comes naturally to them I guess.

Great post.

the individual voice said...

OK Bubandpie: here's my two cents but take it or leave it, I know nothing of your situation, but I am a mom and a professional psychologist of adults, children, families. Most mental health practitioners still know very little about autism spectrum disorders/interactive/learning styles, whatever. MY BIAS would be to have him seen by a Neuropsychologist who specializes in young children. They are very hard to find, but when you do, that person will spend several hours alone with your son doing all kinds of interactive tests, games, play, whatever to really get to know this child from every possible angle. I'm biased, though. I'm a psychologist, but not that kind. A major pediatric hospital would be a good choice, depending on where you live.

flutter said...

You want I should fly up and kick his butt? Cause I can....

Lady M said...

I hope the doctor is more (at all?) accommodating during your second visit. It doesn't take much for an expert to show caring for his patients! Why don't they all do it?

Anonymous said... true. I had this experience the other day..this exact same one!

Beck said...

Yeah. Doctors.
When we brought the severely underweight Baby into the specialist, her doctor was convinced for the first several appointments that her problem was that her hillbilly parents weren't feeding her. Um, no. So valuable time that could have been spent GETTING HER BETTER was spent defending ourselves and our parenting practices.
I'm sorry that happened. What a prick.

Erin said...

Add also: As you leave the room, with one hand on the doorknob and half you self out of the room, turn to the patient and non-chalantly suggest that they need to start addressing some major issue that you never mentioned previously. Something like, "While he's onlt one and a half, you need to start paying attention to his weight. It's going to be a lifelong battle for him."

Laural Dawn said...

I can SO relate to this. Not about my child - about myself.
I talk a bit about having PPD (very personal issue) and the person I saw about this put me through a similar experience. It's not the same - because it's your child. But, it is in the sense that you leave thinking you are crazier than when you went in.
Remember, it's not you!
The good news is that Bub sees that you are there and standing up for him. He may not understand everything going on, but I'm so sure your concern and love are pretty obvious to him right now.

Janet said...

You are in a frustrating place. It's my humble opinion that arrogance and frustration don't mix.

It's your blog; vent if you want to. We'll listen. And we can sing you a song, to maybe make you smile:

(Sing to the tune of "You Can Dance, by Men at Work")

You can vent if you want to,
You can leave arrogant doctors behind
'Cause Dr. WRE don't listen
And if he don't listen
Well, he's no friend of mine.

Say, you can Google if you want to,
A place that they don't want you to find,
And you can act like you know what you're talking about,
Because you do.

You can vent.

Jaelithe said...

I believe I have met this doctor. Oh, about twenty times or so. He keeps changing his name, though.

Denguy said...

O, joyous sarcasm! How I love thee.

Excellent venting. Lord knows we all need to do that on occasion.

I've just posted about you, by the way.

Lisa b said...

The fact that his manner was upsetting to you, or at the very least not helpful, is a problem.
You need to deal with people you trust. Of course you don't want to go back on the waiting list so all I can suggest from my experience is say what is on your mind.
I don't like it when people take a checklist to me and I don't make it easy for them.
If you are too busy to show some compassion then I don't think you should be working with kids. Even a short conversation letting you know what else to expect in the process would have been helpful. Letting you know that he didn't have answers but when you might get them might be nice.
It is very hard being at the mercy of this system.
You are just starting out, there is a lot to figure out but you are going to be great at it. Trust yourself.

Kathryn said...

Sounds like you need a new doctor. Tell this doctor to "suck it" and find someone else. Like this situation isn't stressful enough? The last thing you need is a arrogant arse to make you feel worse.

Swistle said...

Also, whenever you ask a question and the response is something the patient clearly feels bad about, follow up immediately with a question that implies you believe the situation to be the result of something the patient did. Ideally, the follow-up question should be in "You didn't...did you?" form. For example, if the answer to, "Does he still wet the bed at night?" is "yes," follow up with, "You didn't use pull-ups, did you?"

andi said...

I'm so sorry about this. I went through an annoying situation recently where my GP referred me to a specialist for a "problem" the baby was having. Then it turned out it wasn't a problem after all. I am switching to a GP who knows what she's talking about (this isn't the first incident).

Hope you find your answers soon.

Veronica Mitchell said...


Can we kick him in the shins for you?

alejna said...

I've run into this type of doctor before, too. It's so aggravating. It's the dismissive attitude that riles me up the most.

I enjoyed your venting style. Vent away.

Omaha Mama said...


Jill said...

You forgot the most important one:

"Keep them waiting in your waiting room for half an hour. That will impress upon them that your time is more important than theirs."

Jenn said...

Dear Bub & Pie,

I am a mother who is certain her authority is non-existant.

What can I do to at least look the part?


KC said...

Some old school doctors are like this- no amount of reputation or "knowledge" is worth this. Find a new one.

I used to be on the admission committee of my medical school as a student member. We would screen out the socially inept, pompous, buttheads while casually interacting with them in the waiting room between their formal interviews.

Marian said...

Ugh. I'm with you. Arrogant doctors... I've encountered quite a few. (And, in the end, they didn't know how to solve the problems presented them. Which was always my fault somehow, of course...)

Major Bedhead said...

I'm sorry you're having such a shit time with doctors. Doctors with that sort of attitude should be buried in a research lab somewhere, not working with real people with real feelings.

Rae said...

Good advice, Aunt Bubandpie. It does seem that if one did all these things the patient would leave feeling more alone than ever.

I'm sorry. This sucks.

Ally said...

Ugh. I'm sorry this is how the doc made you feel.

Suki said...

Damn. So That's the same the World Over. Double Damn.

Doctors forget that people without an MBBS degree(that's the preliminary degree in medicine here) aren't imbeciles. They need to be reminded repeatedly of that fact!

And for heaven's sake, DO NOT go with something against your instincts! If you feel no one suits, take care of Bub on your own... way better than a bad shrink.
Good luck, again!

Aliki2006 said...

We've had *lots* of those experiences with our's frustrating.

As for Bub, I know shamefully little about Canadian healthcare with respect to early intervention screenings, etc. but surely there are other routes you can take? I know when my son was evaluated through his school it was extremely intensive--lots of different steps, observations, forms--it was a process that took weeks and was done by a team.

Even if finding another doctor takes some months, you do have time on your side as Bub is still young. Things may change in a few months--or not--but it might be worth the investment of the extra time.

I'm sorry about all this--how frustrating.


That's rough, your doing a good job of taking care of your boy, and pressing through to make sure he gets the care that he needs. Don't let the doubts flood in that your obsessing(I'm referring to your last post) because your truly not. Your thoughts are on your child first and foremost, and he'll grow up healthier because of it.

bubandpie said...

Aliki, TIV - There's no question that Dr. WRE is knowledgeable - he really is a bigwig in the world of PDD research. He's one of a three-member diagnostic team - we'll go back Oct. 9 to see the psychometrist and then on Oct. 30 we see Dr. WRE again along with a speech path. So we'll see how things develop over the next two appointments. I'm not sure how much, if any, role Dr. WRE would have in Bub's treatment if he is diagnosed with a PDD.

It's not clear to me, in retrospect, that he was dismissing the idea that Bub has a PDD (in fact, he carefully avoided saying that). The problem was his dismissive manner, which made me feel like crap, though it may or may not have any bearing on his ability to assess Bub.

If we come out of the Oct. 30 meeting with no diagnosis or services, I've got some ideas of steps to take next - stuff that I'd be paying out of pocket for, and probably traveling to get, but that would involve going for the interventions I think would help him rather than the label.

Momish said...

I think your response to Mr. B&P says it all. You are tired, you are sore and you are angry. You have every right to be all those things too. Sadly, doctors and experts in their field should realize that most parents are coming to them exactly as you are, feeling all those things.

I am sorry his bed side manner just wasn't up to par.

Susanne said...

Wow. How you manage to turn these things around. I'm in awe.

Stimey said...

Doctors are tough, especially when dealing with autism. Every single time (EVERY time) I take Jack to the pediatrician--for whatever it may be--the doctor tells me that people say Bill Gates has autism. Reassuring, yes. Weird, also yes. I sort of wish he'd give me something more concrete. He FINALLY said that he thinks Jack is PDD. We'll be going to his developmental pediatrician this month and I'm going to ask her how to pursue a dx. I'll definitely be watching your and Bub's progress. Thanks for your comments over at my place. It's really nice to know that others feel the same way as I do.