When Docs Are in Doubt

There's a reason doctors started acting godlike: some patients wanted to believe it wasn't just an act.

By Mary Carmichael
NEWSWEEK
Updated: 3:17 PM ET Dec 15, 2007
http://www.newsweek.com/id/78155

Few people know better than I do that doctors are imperfect beings: I married one, and for all his brilliance, he sometimes leaves the toilet seat up. I keep that in mind when I interview other docs for NEWSWEEK. They, too, are prone to the occasional error; they don't always have all the answers. A few don't like to admit that. They'd rather seem omniscient or at least supremely confident, in line with the old surgical saying "Sometimes wrong, never in doubt." But lately they're in the minority. More of the doctors I encounter now want to talk about their doubts and mistakes, not paper over them. They are willing, and even eager, to be seen as human.

They're right in tune with popular culture, which has replaced the image of the all-knowing healer with that of the highly educated guesser. In thoughtful, bestselling books, Jerome Groopman ("How Doctors Think") and Atul Gawande ("Better: A Surgeon's Notes on Performance") have laid bare the workings of the medical mind, which, it turns out, works pretty much like any other. Doctors, we learn in these books, don't always know what's wrong with their patients or what to do in response. They grapple with uncertainty. Increasingly, they're sharing that fact with their patients, because that's what patients say they want to hear, says Dr. Nananda Col, who studies medical decision making at the Center for Outcomes Research and Evaluation at Maine Medical Center. "Patients no longer automatically accept that the doctor knows best," she says. "They want to look into the black box of how medical decisions are made."

Two weeks ago I had to look into the black box myself. My mother was in the hospital, and no one knew exactly what was making her sick. She had pneumonia, but the bigger problem was with her liver, which was failing for reasons that were hard to pinpoint. The docs did everything by the best-selling books: they admitted their doubts. They had a good theory —she might be reacting to an antibiotic—but they couldn't rule out other possibilities. They scheduled precautionary scans and tests. My parents (and, for the record, my husband the M.D.) didn't flinch. Yes, they wanted to know what was wrong, but until the doctors figured it out for sure, they could wait.

I, meanwhile, went batty. Everything I knew about doctors' fallibility, I promptly forgot. What did these people mean, they didn't know what the problem was? That was their job! All I wanted was a doctor who would swoop into my mom's room—if not on a white horse, then in a white coat—and save the day. I knew that this doctor probably didn't exist. But I had long since ceased to be rational.

There's a reason doctors started acting godlike in the first place: some of us wanted to believe it wasn't just an act. For most people, uncertainty is terrifying, especially when the thing that's uncertain is whether we'll live or die. Sometimes we need a sense of security, even if we know it may be false. Trying to reduce uncertainty "is our natural way of coping with horror, helplessness and hopelessness when reminded of our own human transience," says Harvard University psychiatrist Harold Bursztajn. Now that doctors have been outed as regular people, patients may have to give up that coping mechanism, and it won't necessarily be easy. For all the books that encourage doctors to "tell their patients exactly how murky the waters are," says Col, there's very little research on how patients actually respond to that kind of frankness. Some, like my parents, accept it with grace. Others, like me, don't. Doctors are going to have to deal with us both.

My mom, by the way, is now recovering at home. Her docs are pretty sure the antibiotic was the culprit. But before she left the hospital, they told her that if she ever took that drug again, she might not have a reaction at all. Who knew? I guess I should be glad the doctors admitted they didn't. I still wish they did.