machado: doctors can't know everything, but aita for expecting a google search?
by the time the dermatologist had moved on to my butt in her search for suspicious moles, i was trying to feel better about the fact that she not only didn't make the effort to answer my question, but she also didn't think to use her expertise to ease my mind.
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a study published by the society of general internal medicine found that many doctors didn't communicate completely with patients. getty
there’s this trend on social media called aita (am i the a**hole?) where someone writes about a personal conflict and then opens themselves up to be judged, asking readers, “aita?” readers then weigh in with their opinions.
it came to mind this week as i lay under a paper blanket with just my tiny clothes on waiting for a dermatologist to do my yearly skin check. i go because as a kid and teen i had a whole bunch of bad sunburns — we’re talking bad enough to cause painful watery blisters — which has, in turn, covered me with every shape and colour of mole.
my father also had basal cell carcinoma — not the deadly kind of skin cancer, but bad enough to warrant regular screening. add in my daily chemo medication that, according to some doctors, could potentially up my risk of the deadly kind of skin cancer and it’s a trifecta of all the criteria needed to lock in a lifetime of derm appointments.
it bothers me that no one knows for sure how the drug that i take impacts the likelihood that i could develop another cancer. it’s an uncomfortable unknown, both because the medication hasn’t been around long enough to have meaningful data on secondary cancers, and also because people tend to develop cancer as they age and it’s tough to determine whether another cancer is caused by their medications or simply due to age. but ever so often i ask the experts, hoping that maybe there’s new research to shed some light.
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when the dermatologist walked into the examining room, her movements were measured and precise in a “i’m-not-stressed-boy-am-i-stressed kind of way. she sat down and then stood up again; pushed her long red hair behind her ear with one hand and scrolled for a second on her watch; then she sat down again to read my file. as she scanned the computer screen, she talked about how short-staffed she was, that it was just her and her assistant — “i am sure she greeted you in the lobby” (no one greeted me). she went on to say that most of her team had decided to retire, while the others were on maternity leave with no definite plans to return.
“it’s a tough time,” she said, with a really long sigh.
then, “still on the cancer med?” she asked, staring at the screen. when i said yes, she was back on her feet. partly to distract myself from the fact that she had removed the paper cover, and i was lying there pretty much naked under very unflattering and blinding ultraviolet lights, i asked if she had seen any recent research about links to skin cancer and my cancer drug. i also mentioned that it was something that i worried about, particularly when new moles keep appearing.
she sighed again, her thin, smooth lips ballooning out as she pushed air through them loudly.
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“i don’t take time to research every cancer treatment.”
i knew she was having a rough day and she was stressed and probably tired. plus, she was likely aware that there were nine people sitting in the waiting room to see her, so time was of the essence. still, i couldn’t help wonder why she wouldn’t just look my question up. after all, i was her patient, concerned about the impact of my medication on my risk of skin cancer and she was a skin expert.
aita?
by the time she had moved on to my butt in her search for suspicious moles, i was trying to feel better about the fact that not only did she not make the effort to find an answer to my question, but that she didn’t think to use her expertise to ease my mind, or at the very least, talk about the ways i might reduce my risk — both of which could have been done in the time it took to check one butt cheek.
and so the conversation began in my head. it’s not that big of a deal, i thought. after all, i could easily look up the question myself. plus, it’s probably fine, there’s probably no reason to worry. if there was a risk, someone would have probably mentioned it already. besides, i could call my cancer doctor and ask him. then came the worst, most disempowering thought ever: at least she was able to see me. just like that, the hope and expectation that i carried into the examining room that day — that i would get a clearer idea of what kind of risk my medication posed for me, which would allow me to make decisions to mitigate it, like, for example, schedule more frequent skin checks — was instantaneously ground down into teeny crumbs of mere gratitude that, despite my larger concerns, at least my butt was getting some attention.
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it’s not like i expected her to know everything. but sort of like last month, when the cashier at a local art supply store took a moment to google the “best types of glue for glossy paper” after i mentioned that i was mounting a poster to the canvas i had just paid for — it feels good to have someone take that extra step to make sure things work out the way you want them to. and as a patient, someone having your back should not be too much to ask for.
and sure, in the current health-care system climate — in which we don’t really have much of a system at all — where medical professionals are burnt-out and overloaded, much like just about every emergency room in canada, one could argue that, yes, in fact, asking for that extra step is actually too much. except that even before the pandemic stretched our hospitals, and our ability to care, to near extinction, patients were feeling the effects of doctors who — and not necessarily purposely — didn’t think to go the extra mile.
in 2018, for instance, a study published by the society of general internal medicine found that many doctors didn’t communicate completely with patients, either not taking the time to ask questions or interrupting them, creating a “lack of collaboration,” according to the study’s lead author, dr. naykky singh ospina. this, even though uninterrupted patients tended to take an average of just six seconds to get to the core of their concerns.
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perhaps more telling were the findings of another study that saw patients rating their doctors higher in terms of the amount they communicated than the doctors rated themselves — a result author dr. jenni burt attributed to the reluctance of patients to criticize their doctors because they needed “to maintain a relationship.”
sometimes, you’re just not up for the fight
i get that. the penchant of people to accept less than what they need from those they perceive essential to something they care about, whether that be a place to live, money or yes, health, makes total sense. sometimes, you’re just not up for the fight. other times, when your heart tells you it’s worth it, you look up to the heavens, curl your hands into tight fists and whisper, “bring it.”
that day, sitting in my underwear with a tired and stressed dermatologist, wasn’t one of those times for me. i didn’t go beyond the tussle in my mind to challenge her, or demand that she take a moment to really listen to my concerns. instead, i walked through the crowded lobby with a smile for the assistant who had come out to explain why appointments were running late, feeling grateful for a clear skin check.
aita? not that day.
lisa machado is the executive producer of healthing.ca. follow her @iamlisamachado.
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