Dinner-party diagnosis: The occupational hazard of being a doctor

There’s not a doctor on this planet who hasn’t given out free medical advice to family, friends and even total strangers. It’s happened to me twice just as I’d arrived in a foreign country. The first time, after a passport control officer asked me what my job was and I’d responded, “I’m a physician,” he launched into a query about his arthritic hip. The second time, a uniformed young man suspended his passport stamp in midair, asking: “Oh, you’re a doctor? If a pregnancy test is negative, how long do you have to wait to be absolutely sure there’s no baby?”

Usually, doctors are happy to help out in such situations. But that’s not always the whole story. Here’s what’s actually going on in the doctor’s mind when people ask for informal advice. Mary Kiehl, an internist at Washington University in St. Louis, says that giving casual consultations is part of her social obligation. In a way, she says, it’s payback for the privilege of being a doctor. “I am so grateful to have received a wonderful public education in the state of California – thanks to the taxpayers of my home state. As trainees, we’re the recipients of tremendous time, effort and resources. I think that privilege brings with it an obligation to be generous. If someone wants me to listen to their medical problem, I’m almost always happy to do it.”

Yalda Jabbarpour, a family physician at Georgetown University Medical Center, puts it more bluntly: “As a doctor, you’re always on.”

Truthfully, there are times doctors don’t want to be on. The reasons can vary.

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I remember in medical school when one of our professors, a well-known dermatologist, described the challenges of being a skin doctor at a cocktail party. Everyone always seemed to have a blister, bump or bruise they’d want him to look at. One man turned around and pulled down the back of his pants to reveal a rash at the top of his gluteal cleft.

“What do you think, doc?” he asked. The dermatologist knew right away what the problem was. “That’s herpes,” he said, embarrassed – but maybe not as much as the man who’d asked.

Ranit Mishori, a colleague of mine at Georgetown University School of Medicine, describes a group hiking trip she recently took in the Alps. On learning she was a doctor, one of her fellow hikers launched into the details of his medical saga for the better part of an hour. He had weakness that turned out to be a viral infection, but it hadn’t been diagnosed until he’d been to three specialists, each of whom performed a slew of sophisticated tests. And that was it – one hour of Mishori’s vacation spent in medical consultation for no discernible reason.

Understandably, patients find their experiences with illness infinitely interesting, but they can be all too commonplace to the physician, who has seen similar cases hundreds of times. Paradoxically, the last thing we physicians would wish on our friends is that they be an “interesting case.” An interesting case is usually one that is unsolvable or, worse, suggests a serious or even fatal condition.

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So, yes, when we hear about some bowel symptoms or excruciating dental work (the details of which we are often treated to even though we aren’t dentists), we are much relieved to know the humdrum nature of the experience but equally relieved when the story is finally brought to a conclusion.

Being “on” at all times can also mean being available in other, more dire ways. It’s not unusual for doctors to have to respond to public emergencies. Many doctors will sheepishly admit that when they are on a plane heading to some well-earned beach time, they cringe when the flight attendant calls for a doctor.

Mishori, a family medicine doctor, tells the story of just such an experience as she and her husband were flying over the Caribbean. Responding to a request for a doctor, she headed nervously toward the back of the cabin, not knowing what dramatic maneuvers she might have to perform. So she was quite happy to see another doctor already at the scene. Unfortunately, that doctor was just as relieved to see her. “What kind of doctor are you? I’m just a psychiatrist!” he said.

Helping out in an emergency isn’t really a choice. We do it even if we don’t feel well equipped to pitch in. Kiehl recalls being at the scene of a traffic accident where several people were already dead, including one of the drivers, a woman whose skull had cracked open on impact. While Kiehl was tending to the woman’s husband, he kept shouting at her: Why wasn’t she treating his wife? The memory of that agonized plea haunted her for months. But another time, while cheering on friends at a marathon, she performed CPR on a runner who’d had a heart attack, saving his life.

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Mostly, though, the medical situations doctors deal with outside their routine settings are low in drama. I’ve often checked the ears of my neighbors’ kids when their parents were worried about colds. Not too long ago, I examined a neighbor with Parkinson’s to help diagnose his abdominal pain. (My suspicion that his problem was caused by constipation spared him an emergency room visit.)

Another time, I went over to a neighbor’s with a scalpel blade to help “Grandpa” with a nail infection. I drained the pus that was gathering around the nail of his index finger. The next day, he stopped by and showed me his finger, bending the top part down so it looked like a stump. “Look,” he joked, “it fell off.” In fact, his infection was healing well.

The possibility of a bad outcome is certainly a liability when treating people outside the office. But most of what patients want isn’t treatment; often they’re just looking for a sympathetic ear.

That’s why giving friends and family advice isn’t a burden, according to Kiehl. “It’s less of a burden to me than actually caring for my own patients; I don’t assume responsibility for the issue. I just listen and offer gentle guidance, reassurance or empathy.” With patients in your office, you have to follow up. You’re responsible. But when you’re just another guest at a Fourth of July picnic, all you’re being asked for is supportive conversation. “It’s the rare person who expects to approach me casually for a definitive diagnosis or treatment,” Kiehl says. “And that’s not something I can provide in a social context.”

If anyone needs proof that we’re happy to offer advice freely, here’s this: We don’t ask for anything back. Of course, sometimes people find ways of expressing their gratitude. “Grandpa,” the neighbor I treated for a finger infection, showed up again a few days after his nail had healed, carrying a brush and a can and a roll of some sort of vinyl. It turned out he’d come to repair the linoleum in my kitchen. In fact, he’d never been in my kitchen, but word must have gotten around that there was a tear in my floor. And he fixed it so perfectly, you couldn’t see it had ever been ripped.

You never know where gratitude will show up. When Kiehl performed CPR on the marathon runner, the police deliberately chose not to include the doctor’s name in their report. They were respecting the “good Samaritan” concept that bystanders who are trying to help in an emergency should be protected from legal action if anything goes awry. So when the ambulance came for the man whose life she’d saved, Kiehl never expected him to contact her. But he always wanted to tell her how grateful he was. One day while buying sneakers (he was up and running again), he told his story to a saleswoman at the store. It so happened that she’d heard about his resuscitation from a friend. “Oh, I know who you mean,” she said. “That’s Dr. Kiehl!” And so the man was able to write the doctor a letter and thank her.

Those are the sorts of outcomes of our off-duty existence that we doctors find particularly gratifying.

But there are certain informal patients who can make my physician colleagues uncomfortable:

– Someone who is angry about an interaction with a doctor or a poor outcome and wants us to confirm they received poor care.

– Related to this, people who tell us things that reveal other doctors’ errors or problems in the health-care system.

– People who want a firm second opinion off the cuff.

– People who pick an indelicate time or place for the conversation.

– People who are involved in a lawsuit and want to draw us into their dispute.

– Friends and relatives who send texts with pictures of weird lesions from indecipherable body parts.

Most doctors agree that if all a person wants to do is fascinate us with the sordid details of their seemingly interesting story, they should keep it to themselves. In such situations, we have little concrete help to offer.

On the other hand, if patients want some direction on what to do about a symptom or illness, most of us welcome their inquiries. Especially if someone wants:

– Advice on whether they need to check in with their doctor or whether they can just ride out their symptoms.

– Clarification about something their doctor told them or about a medicine they are taking.

– Ideas for home remedies for minor problems.

– A little TLC for self or family.

Within reason, we’ll even take a peek at a rash or inside an ear, as long as the requesting individual is prepared to get what they asked for: our honest opinion.