The Intro to the Intro
For those who were hoping for a sober or analytical piece this Sunday morning, be warned that you have entered a No Wonk Zone. Today’s post, hopefully will make a serious point, but it is seasoned with some levity and a little silliness. Of course, just because I think it’s silly, doesn’t mean that you will agree with me. The definitions of silly and serious are highly subjective. One man’s ‘dead serious’ is another man’s ‘deadpan'. For example, after watching the recent health care reform summit, I couldn’t tell if it was a serious policy exchange or a silly infomercial. Could you? Yes, I confess that this is an entirely gratuitous jab at the President's daytime TV health care reform special.
Every physician has been asked, “Doctor, what would you do if I were your mother?” The patient, who assumes that the doctor likes his mother, erroneously believes that this is a surefire method of receiving premium medical advice. After all, who wouldn’t want to receive the same medical advice that the doctor would give to his own mother? Extending this flawed logic into the realm of absurdity, the patient could generate a range of medical options from his doctor, simply by using the index question above as a template, and substituting other folks in place of ‘mother’. Watch how this works.
The Hypothetical Patient
A patient comes to the doctor with chest pain (CP). The physician recommends a stress test. The patient wants to verify that this recommendation is ideal. In just a few short minutes, the patient can use the fill-in-the blank template technique to produce a spectrum of medical options. Of course, the inquiry , “Doctor, what would you do if I were your mother?”, should come last so that the patient can readily see by comparison that this is the ‘mother'-of-all-medical recommendations. Any option, possession, idea or medical advice gains currency when it is surrounded by inferior alternatives.
The Template Question in Operation
The patient with chest pain poses 10 questions to the physician using the template that appears below. Each question substitutes a different person in the blank space. As you will see, the physician’s advice is different in each case.
“What would you do if I were your _______?”
Person Physician’s Medical Advice
Congressman.....................Sorry, fillibuster is in progress.
Quack................................Take a high colonic STAT!
Telemarketer.....................I’ll call you back at dinnertime.
Customer Service Agent....Your call is important to us...
Teenager...........................The CP is the teacher's fault.
Personal Trainer................No pain, no gain. Drop and give me 10!
Accountant .......................The pain will depreciate over time.
Lawyer...............................I refuse to answer.
Psychiatrist........................Are you envious of your CP?
Mom..................................Answer appears at this post's end.
I have never responded to the ‘mom’ inquiry directly, but I try to provide the patient with the reassurance that is being sought. Patients ask the mom question to give us doctors a few moments to reflect on our medical advice. This is their version of, “Is this your final answer?” But, of course, the medical advice never changes, and it shouldn’t. Consider this vignette.
Physician: “I think you should have an ultrasound of your gallbladder because your symptoms sound suspicious for gallstones.”
Patient: “What would you do if I were your mother?”
Physician: “Oh, in that case, I think you should have a colonoscopy.”
I am amused when a referring physician notifies me in advance that a patient being sent to me is a rich executive or some other version of a VIP patient. Am I supposed to ramp up my medical quality as if I have multiple standards depending upon the prominence of the patient? Should I make sure the colonoscope is extra clean for all corporate CEOs or high government officials? Do I have 2 different sets of textbooks (remember textbooks?), one for ordinary patients and better ones for special customers? There have been many commentaries and medical journal articles that point out that VIP patients don't reliably receive 'VIP' medical care - particularly when the patient is a physician. In these cases, standard medical practices and procedures are often bypassed and corners are cut. Medicine works best when there is a single high standard of care for every patient.
I am not my mom’s doctor. I couldn’t possibly answer how I would treat her medically, in response to a patient’s inquiry, because I am her son. I don’t have the necessary objectivity to advise her, and I wouldn’t want the role in any case. There’s a reason that physicians shouldn’t treat their own family, or even close friends, in my view. It’s just too messy and it can contaminate the personal relationships.
So, when a patient asks me what I would do if the patient were my mother, I always offer the same response. I’d tell my mom to speak with her own doctor.