July 30, 2011
I just read an article about expectations in medicine. Expectations can make or break a relationship. They can be the source of great excitement and joy or of great disappointment and sadness. Expectations, in medicine need to be clearly defined and, when possible, successfully met.
Several years ago, I did a full physical on a new patient. Patient “X” had been referred to me by a mutual friend and I did my usual, thorough job. I was dismayed when my friend called me to report how disappointed patient “X” had been!
I called patient “X” to discuss the results of his exam and why he felt I did a “crappy” job. Mr. “X” started with, “Doc, I like you but you did not do/order a stress test, Carotid Doppler, lung function test, PSA or colonoscopy. I went to Dr. “Y” and he ordered them for me!” To Mr. “X’s” surprise, I asked him why he thought he needed those tests. Mr. “X” responded, “My partners’ docs ordered those tests.”
In retrospect, the problem was obvious. Mr. “X” had expectations I did not meet. I had expectations, as well. My expectation was that Mr. “X” wanted a thorough, customized physical. “Mr. “X”, I’m sorry you were unhappy. Let me venture a guess: your partners are all in their mid sixties.” His answer was “yes”. “Mr. “X”, had you been in your sixties, I would have ordered those tests and perhaps more. You are 41 years old and, with your personal and family history, as well as excellent physical condition, I did not feel you warranted any of those tests.”
Mr. “X” cancelled all of his tests and sees me yearly for his exam. I learned a valuable lesson. My patients’ expectations may not match mine. Setting realistic expectations are an important part of any doctor-patient relationship. Patients must recognize that doctors have expectations and doctors must realize that patients have their own, distinct expectations.
Expectations can range from fantasy to reality. In the medical arena, it is crucial that expectations be founded in reality. As your doc, I expect you to follow my instructions. I expect that, if you are going to vary from my instructions, you will let me know. These are realistic expectations.
An example of false or unrealistic expectations would be if you were 75 pounds overweight, drank a bottle of wine and six cocktails, and smoked two packs a day; and I expected you to lose your excess weight while giving up smoking and alcohol simultaneously within 6 months. (I would give the above patient at least 6 1/2 months).
Sometimes I set unrealistic expectations for myself and my patients. When the stakes are high enough, you do what you have to do in order to survive. Unrealistic expectations can be met when truly necessary!
Patients often set unrealistic expectations. The most common example of an unrealistic expectation is when the patient, mentioned above, expects his doc to cure his cough, repair his damaged liver, and save him from the heart attack he is about to have. Doctors don’t heal patients, they help patients heal themselves. Expecting your doc to save you from a sinking ship while you are punching holes in the hull is another example of false expectations.
So what can you do? Discuss your expectations with your doc. Let him/her know exactly what you want; what you are thinking. Be sure of what your doc expects of you. Expect that your doc will work (I hate the word “try”, http://livewellthy.org/2010/11/28/try.aspx) at meeting your expectations. If he/she falls short, discuss it with him. Work at meeting your doc’s expectation. Expect that your doc will confront your shortcomings, as well. Most of all, be honest with yourself and your doctor.
P.S. – I believe in miracles. I have been blessed to see many miracles in the last 28 years of practice. It is ok to have false or “fantasy” expectations, as long as you know that the only way they will come true is to receive a miracle. It is not OK to sell yourself on false hope as the vast majority of time it will end in disaster.