When The Doctor Isn’t Sure: What You Can Do
We have all taken a sick child (or a parent, or a spouse, or ourselves) to a doctor’s office or emergency room looking for answers to worrisome symptoms. But what if, when the time comes, there are no answers?There are life-saving questions we can ask to start a dialog, a conversation, to make sure the doctor hasn’t overlooked something that could cause a terrible injury.Consider this common scenario: You’ve waited for a long time, in both the waiting room, and in the cramped examination room. The doctor comes in, asks a few questions, does a brief exam, and then … the doctor shrugs and says, “Its probably … nothing.”
But the doctor isn’t really sure, and so you, the worries parent/spouse/patient looking for clear answers, are left even more worries.
If this hasn’t happened to you, it will at some point. I want to arm you with key questions you should ask and things you should do to protect your loved one’s health. These are conversations that can truly save life: yours or a loved one’s health.
The Most Vital Question You Can Ask Your Doctor
When it’s clear the doctor doesn’t know what’s wrong with the patient, one simple question is very important to ask:
“Doctor, what else could it be?”
This question is not for every visit. But it’s a great, important, even lifesaving question when:
The doctor obviously hasn’t fit all the pieces of the puzzle together, such as when the patient has developed symptoms that don’t fit neatly into one diagnostic box:
a. The doctor is unsure about what’s wrong but tried to reassure you that it probably is nothing to worry about: or
b. The doctor has seen the patient multiple times, and the patient’s body isn’t responding to his or her treatment plan.
This simple question – what else can it be? – can seem rude and impertinent to put to someone in a white coat. But there’s a deeper problem that makes many of us hesitate to ask. Especially when the diagnosis offered is benign, it’s a lot easier to embrace a vague pronouncement like “probably nothing” than to entertain the idea that something bad may be lurking undiscovered within our patient, something that might rear up and cause permanent harm or even death. Who but a hypochondriac would challenge the diagnosis of “probably nothing”?
It’s the job of the health-care professional to take the patient seriously. A doctor who looks first for a benign source for the patient’s symptoms rather than for those things that can kill the patient does no service to the patient. We don’t take our children to doctors to feed our natural instinct for denial. We go to doctors to make sure that something really bad isn’t happening, and if it is, to find the right treatment to make it better.
The question, What else could it be? is intended to prod the physician into a thinking exercise she learns in medical school: the differential diagnosis. Here’s how it works. The physician takes the patient’s significant findings and makes a list of all the diseases that could fit. The list is supposed to be prioritized to put dangerous treatable conditions first. Often, though, the doctor makes a probabilistic diagnosis as a shortcut: If it’s very likely this is just, say, a common cold, the doctor doesn’t bother with the tests that can determine if it’s a more serious bacterial infection that needs antibiotics
Read on for more good questions to ask the uncertain doctor.
Talking to Your Primary Care Doctor: What You Need to Ask
Here is what else you should ask when the doctor isn’t sure about what’s wrong:
- “Is there any chance that my child (my spouse, etc.) has a condition that can be treated now but if not caught soon, could be a disaster? If so, how do we get to the bottom of that?
- “Are there any symptoms or test results that just don’t fit your diagnosis? If so, what else could be going on?”
- “You say the patient has two separate, unrelated things wrong. Is it possible there’s just one thing wrong that explains all the symptoms?” Or,
- “You say you’ve found one thing wrong. But that doesn’t explain all the symptoms. So is it possible there is more than one thing going on?”
Final thought: Get a written action plan from the doctor when you leave the visit. If things are uncertain, it’s very important for you to know exactly what to look out for and what changes in symptoms should bring you back to the doctor’s office.
Why Doctors Are Vulnerable to Misdiagnosis
Research says that as many as 15 percent of all medical diagnoses are wrong. Any misdiagnosis causes wrong treatment. But tragedy lurks in one distressingly common type of misdiagnosis: the assumption that the patient has a benign, self-limited condition, when in reality the clock is ticking on a treatable serious disease that could kill if left untreated.
Pediatricians are vulnerable to misdiagnosis, not because they’re bad doctors, but because they see so many healthy children with benign illnesses, that on occasion when a child appears with a really serious condition, they mistake it for just another ordinary illness.
The same is true for any frontline, primary care doctor: whether they are an internist, a family practice doctor, an emergency room doctor, or even an ob-gyn in general practice, they see an awful lot of really plain vanilla mild ailments that will go away whether treated or not.
It’s natural to want to fit a new patient’s symptoms into a familiar box. It’s when the patient doesn’t fit the box comfortably, and the doctor sort of understands that – as shown by unease or lack of certainty – that we need to gear up our questions and get our physician thinking along the lines of differential diagnosis, beginning with the most dangerous, treatable diagnosis first on the list.