Docs opinion

Bruno, Michael mbruno at HMC.PSU.EDU
Thu Jul 23 22:19:25 UTC 2015


Dear Victoria & Amy,

Speaking as a physician, I think it is extremely likely that Amy is correct in her expectation that your current physician will be happy that the diagnosis was made by someone else, and will not be upset at all that you saw another physician.

Medicine is a very human enterprise, after all.  We physicians are all very much aware of our own limitations and most of us understand that sometimes things work out (or not) by random chance/luck.  Amy’s analogy of someone winning the lottery because a convenience-store clerk made a mistake and entered other numbers than the ones that were asked for is very astute.

In my 25+ years of practicing medicine I have encountered only a small handful of malignant narcissists, and I agree with Amy that they are generally not good doctors (although many have amazing skills in a narrow skill-set).  They tend to gravitate toward the procedural fields, in my experience, and are rarely PCPs.  Since you feel so positively about your doctors, I’m sure they fall into the majority (kind, caring people) and not into the small minority of narcissistic personality disorder types that occasionally get into medical school.  So I would tend to doubt that they would react negatively to learning of this and I personally wouldn’t hesitate to tell them all about it.  They may feel badly that they didn’t think of it themselves, perhaps they may even feel a little guilty, but they will almost certainly not feel angry or betrayed or insulted.

I agree with Amy completely that you should feel absolutely fine about this situation.  You are supposed to be advocating for your own health, after all.  That’s what we all want our patients to do.  And there is nothing wrong with letting your trusted doctor know that someone else saved the day this time.  It shouldn’t jeopardize your relationship.  If they are like the 99.99997% of doctors I’ve known and worked with over the years they will absolutely share your joy/relief, and will be just as grateful to the other doctor as you are, or nearly so.

Funny anecdote: I had a brief, cordial encounter with my mother-in-law’s elderly next door neighbor.  The kind of thing you would probably not find memorable in any way under usual circumstances, because it is typical that strangers who have a common acquaintance will treat each other politely and cordially.  I later learned that this person, upon discovering I was a physician, expressed surprise.  He apparently exclaimed that I was very nice and “down to Earth,” and that “you’d never know he was a doctor.”

Not sure what to make of that.

All the best,

Michael A. Bruno, M.D., F.AC.R.
Professor of Radiology & Medicine
Penn State Hershey


From: Amy Reinert [mailto:amy.reinert at GMAIL.COM]
Sent: Thursday, July 23, 2015 5:47 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Docs opinion

Victoria,

First, let me say I'm so sorry that you've had to endure suffering with your health.

It is true, as you seem well aware, that despite the fact that many physicians have extremely large egos, they do not have the ego-strength to be questioned or found wrong. As both a professional and a human being, I would hope your current physician would have nothing but joy for you in discovering another piece of your puzzle. Some of the physician's initial response might have a lot to do with how you deliver the message, but even if the response is initially abrasive, you will learn a lot about his/her personality and integrity if he or she doesn't settle right in and get to work doing the right thing for you.

Just my two cents, but it seems to me that your first loyalty is to yourself. You only get this one body to live in. The medical professionals you seek help from might offer valuable expertise, or they might not. If the doctor is put off by your seeking second opinions, asking questions, or politely advocating for your own health, then I would be willing to bet real money that he or she is not a good doctor, regardless of title or position. There are some whiffs of malignant narcissism and arrogance in that sort of behavior, and I state without  reservation that an arrogant or malicious narcissist will never be a good doctor--- the kind who will save your life when you are really in trouble.

Still, the medical system exists out there, and patients are still generally treated badly within it. The docs keep the notes and the people who write the official note have the power, like it or not. And then there are insurance companies...

So, in response to the advice you requested, how about just stating what you wrote here? You respect and trust them, but this thing turned up and aren't we all lucky that this other doctor had the inspiration to order this other test. Kind of like winning the lottery because the clerk at the store you don't usually stop into, but did that day, made a mistake keying in your ticket.  Maybe not the best analogy, but in general, I think it's good to count our blessings even when we have to trip over them to see them.

All the best,

Amy Ruzicka, Ph.D.


On Thursday, July 23, 2015, Vic Nicholls <nichollsvi2 at gmail.com<mailto:nichollsvi2 at gmail.com>> wrote:

I have a regular group of docs I trust and respect. Recently, I happened to go to another PCP vs. my regular PCP; this doc did some different tests and they found an issue.  Very serious issue. It has grown worse.

I don't know how to let my PCP know that. I don't want them to think I betrayed them, that I don't respect/trust them & their expertise/opinions. I truly want them to learn from this, but I don’t know how to put this to them delicately. I had a previous experience where I got 2nd and 3rd opinions and when I went back to the original doc with what happened, it did not end well. At all.

My current PCP has my confidence & respect, the expertise/knowledge and the access to many more varied/indepth resources I need as a "zebra". I admire their work ethic & their integrity. It means a great deal to me to keep them & our relationship, enough so that I’m concerned about that as I am these test results that are worsening faster than expected.

How do I come out of this with a stronger relationship over this issue? Suggestions on how to deal with this?

PS I do NOT consider this a mistake or any fault of my doc. The testing they didn't do is NOT an error in judgement. Pretty much by the guidelines.

Thanks,

Victoria

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