It’s Medicine Mondays again and this should be a short post-Christmas post, about Happy Holidays and Free Consultations For All.

Photo from: QuickMeme

What do you mean Happy Holidays and Free Consultations for All?

During the holidays families come together and everyone talks about what has been going on since they last saw each other. However, if you’re a physician, especially if you’re one of the few (or only one) in your family, then a lot of the conversation will be focused on their healthcare.

This may be hard to deal with because you will be hearing a one-sided explanation of the story. On the one hand, this story is coming from a family member you trust and you want to believe what they are telling you. However, on the other hand, you are a physician and you want to believe this other physician is trying to do the right thing.

You don’t want to step on any toes.

So let’s step back for a second:

Remember your audience.

When Aunt Edna comes to you and starts asking about this new medication her geriatrician put her on that she can’t pronounce and doesn’t like, try your best to get as much of the story. Additionally, I would recommend that you always preface anything you say with “Remember, I’m not your doctor, and I don’t have the whole story. I will try my best to help you to understand.”

Know your limitations.

If you’re a radiologist (like me), and your father-in-law starts asking about things that his rheumatologist or nephrologist said… you may be tempted to dive deep back into your training as a medicineintern and start talking like you know something. But please remember, you’re not a [insert subspecialty name] here. However, just be virtue of being a physician, you are much better equipped to understand what your family member (and their doctors) are saying. Your job is primarily that of a mediator. 

Don’t be afraid to look things up.

If your family member starts spouting off the 10 different medications they are on, of which you haven’t heard (or prescribed) any of before. Then go ahead and look them up. That’s what Google is for. There is a wealth of information available online at your fingertips. However, because you are a physician you have the ability to narrow down the information to what they need to know and want they want to know. These are not always the same thing.

Explain as clearly and concisely as you can.

You’ve taken pharmacology and you understand the complexities of the drug interactions. Now, you need to explain it to a person who doesn’t understand them.

The most intelligent people I know were able to explain complex concepts which were completely foreign to me in 2-3 sentences. I would venture to say that is the majority of what your consultations will consist of:

“What does this medicine even do?” “Do I even need this?” “Why does this cost so much?”

“Does this medicine cause this side effect?” “Should I see a new doctor?”

“Why can’t you just be my doctor?”

Break down their questions into single answers.

To them, these are all “their problems” so they consider them all together. You should consider them separately and try to distill them down to understand them. Aunt Edna may come to you with a host of complains about her arthritis, Parkinson’s, and heart disease. Then she will toss out about 10 different medications she is on. Most likely, she knows Medicine X is for Diagnosis Y, but she won’t know what it does. She will complain that Medicine X causes Side Effect Z and will ask if you can stop it.

Be careful here.

Try your best to trust your other physician colleagues. 

Remember that you don’t have the whole story.

Just because they were on Medicine X for 6 months and dislike it because of its side effects, doesn’t mean that their physician is wrong. Maybe it was the only medicine that was working -at all-. You don’t know how many other medications or treatments had already been attempted. You are only seeing a moment in time and a one-sided account of the story.

That said. It’s ok to disagree. 

If, after reviewing all the information they’ve given you and doing your own research, you still can’t understand why they are on a certain treatment, then it’s ok to question it. If you are so inclined, leave a note with this family member asking why they are on a particular medication and have them bring it to their physician. It is important to not be confrontational. Maybe something like this:

Example Letter

Dear Dr. Smith,

My name is Peter Jones, I’m Edna’s nephew and I’m a physician specializing in X. My Aunt Edna had questions about the medications she was on and I tried my best to explain what each medication did and why she was on them. However, she demonstrated concern about Medication X because of Side Effect Y. Given the limited information provided to me, I wasn’t able to understand why she was taking this particular medication. I was wonder if you could better explain it to me so I can explain it to her. Additionally, perhaps an alternative exists? Your expertise is appreciated.

Feel free to give me a call at 555-1234 at your convenience and send me an email [email protected].

Sincerely,

John Smith, MD

In my opinion, any doctor worth his salt, when provided with a note like this from another physician would respond in kind.

What about medical students or residents?

This is even more difficult for those who are medical students or residents. Non-medical family members don’t really understand how the “The Track” works. I think some of them think that you are a medical student and jump into doing surgeries and prescribing benzos on day 1.

As a 1st/2nd year student you will still be asked questions pertaining to health care. Remember to preface your answers that you are a pre-clinical medical student and haven’t started seeing patients yet. However, you can still be of great help. Like I said, the majority of questions will revolve around medications, what they do, and why they are needed. A lot of medicine is being able to speak the language, and as long as you’ve done a little pharmacology you’ve acquired some of it.

As a 3rd/4th year student, you must be the most cautious. It’s easy to think that you’ve rotated through multiple different specialties. Maybe you’ve even done a sub-I (or two). You understand the “gist” of things right…? But, trust me, you don’t. Residencies are 3+ years for a reason…  and this is just to establish the bare minimum to practice medicine. You will need another 5-10 years of practice experience to have any kind of “grasp” of your specialty.

So what should I do as a medical student or resident?

However, your family members won’t know that. They trust you 100% because you’re family and you’re a doctor, more so than some new specialist that they just saw for the first time a month ago. They will take your opinion as the holy grail and run with it. If you say that they don’t need a medication, they will stop it. If you say to see another doctor, they will. Be careful here. Despite your best intentions, you may be doing more harm than good. Try to trust your colleagues.

That said, you are all still student doctors. If you truly disagree with the treatment your family member is getting, then you need to research it yourself and figure out what is going on. Have your family member pick up the phone and call the office with their concerns. Have them give you the phone and you should say:

“Hi, I’m John Smith, I’m a medical student and my Aunt Edna has some concerns about her medication (or treatment). I want to help her understand why she is on Medicine X and its side effects.”

Be cordial, not confrontational.

TL;DR

Happy Holidays and Free Consultations For All.

Remember:  It’s just a moment in time and a one-sided account of the story.

Explain to the best of your ability.

You are the best equipped to mediate between your family member and their doctor (even as a med student).

Try to trust your colleagues…

…But it’s ok to disagree. Be cordial, not confrontational.

-Sensei

Anyone else giving out free consultations over the holidays?

How do you approach the situation?

Questions, Comments and Suggestions are welcome.

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