Doctor's Review: Medicine on the Move

August 17, 2017
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What your MD isn't saying

How to read between the lines during your next whitecoat conversation

The test result is slightly abnormal, and it could be several things.
This could mean: "It's definitely one of two things, and I hope it's not the first one." "We may tell the patient initially that there's a 'slight abnormality' because we don't want to worry them," says Leonid Poretsky, M.D., an endocrinologist at Beth Israel Medical Center, in New York City. For example, there are blood-test irregularities that could mean cancer, pneumonia, or nothing at all--but be assured your doctor is thinking of the most serious possibilities. If you want to hear them, ask the right question, Dr. Poretsky advises: "I know you can't tell definitively what it may be, but what are the diagnoses you're considering?"


You need an ESR test.
This could mean: "I have no clue what's wrong with you." The ESR (erythrocyte sedimentation rate) test measures inflammation, says Mehmet Oz, M.D., coauthor of You: The Smart Patient. It can be a shot in the dark ordered for patients with fatigue, weird fevers, or symptoms that might be all in their head. A full-body CAT scan may also signal a doctor's befuddlement.


I've performed many of these operations.
This could mean: "I'd choose a more experienced surgeon." A good measure of a surgeon's skills is how many times he or she has performed the procedure in question -- both the lifetime total and the number per year. "Thousands" is a comforting answer for the first tally, but the annual number is the critical one to know. Replies such as "Quite a few," "Enough," or "I'm comfortable with this" could mean the surgeon is still on his learning curve, says Dr. Oz. You need a specific number.


Our team decided that it was the best course of action.
This could mean: "I don't know what happened during the shift change." People are more likely to avoid first-person pronouns -- "I," "me," and "my"--when lying, according to research by Pennebaker. "One hypothesis is that [deceivers] are psychologically trying to distance themselves from the situation," he says. Reply by asking what he or she specifically did (or failed to do) at the time.


Dr. Smiddle? He's a great guy.
This could mean: "I wouldn't let him touch me." Asking a doctor to rate another doctor can put him in a delicate position. The weasel words? "He's a nice guy," "He's at one of the better centers" (which means not the best center), and the like. What you want to hear are superlatives about the doctor's specific skills.


How serious? Well, it's very serious.
This could mean: "There's a 0.5 percent chance we can sew it back on." Most patients ask vague questions, such as "How serious is this?" and "Is everything going to be all right?" These elicit vague answers. "Make your question as specific as possible, and ask for facts, not his judgment," says James W. Pennebaker, Ph.D., chairman of the psychology department at the University of Texas at Austin.


That growth may be nothing, but I want you to see a specialist.
This could mean: "I'm about 99 percent certain that it's cancer, but I'd rather let another doctor tell you that." A lump. A mass. A shadow on the x-ray. These can be code words for the C-word and signal that the doctor wants you to hear the news from a specialist who has the "you have cancer" talk 20 times a week. If you want the full story ASAP, say so. "If a patient asks if I think it's cancer, I'll tell them," says Ian Blumer, M.D., author of What Your Doctor Really Thinks.


He talked to you for five minutes and ordered eight tests.
This could mean: He's letting the lab do his job for him "If the doctor is pressed for time, he might order tests to get the patient out of the office faster,"says Ian Blumer, M.D., internal medicine specialist with Charles H. Best Diabetes Center in Ontario, Canada and author of What Your Doctor Really Thinks. While Dr. Blumer practices in Canada, he knows this common shortcut happens a great deal here in the States, as well. While ordering exams may seem thorough, or an example of "better safe than sorry," you don't want to take tests you don't need. A false positive could put you through months of hell. Ask him if the tests are critical, advises Blumer, and if they're not, consider coming back for a more thorough examination on a less hectic day (grab the first appointment in the morning, whenever possible). Taking this extra time could make a big difference. "Studies show that the longer the patient talks, the more likely it is that there will be an accurate diagnosis -- but studies also consistently show that the great majority of doctors do not let a patient talk for more than 30 seconds without interrupting them," Blumer adds.


"Do other people annoy you about your drinking?"
This could mean: "I think you might be an alcoholic." A no-brainer, but doctors phrase the question this way to avoid pissing off touchy patients and to increase the odds that they'll get an honest response. "The question is about other people, so it's less likely to offend a patient," says Dr. Blumer. "Surprisingly, you think that people would realize what you're trying to determine, but many don't." A doctor may use this strategy to prod about other habits that may hit a sore nerve for a guy, such as "Does the wife nag you about your eating?" or "Do your coworkers ever hassle you about your body odor?"


"While you're here, hop on the treadmill for a stress test."
This could mean: "I have to pay for this thing." If your primary doctor has diagnostic equipment, such as an ultrasound machine or a treadmill, expect to end up "needing" that test. "It's just human nature," says Dr. Blumer. A doctor can bill the insurance company for administering a test and interpreting the results -- and this pays several times what he'd get for just examining you, he explains. "I would love to have the situation where doctors could never get paid directly for a test they ordered," Dr. Blumer adds. "I'd bet that the number of tests would be reduced by a lot." Ask your doctor if that in-office test is really necessary, and why.


"As I said, this can only be transmitted through sexual activity."
This could mean: "This is awkward, and I'm hoping you'll figure it out." If your doctor keeps repeating a carefully worded answer to you -- one that doesn't quite answer your question -- it may mean you're putting him in sticky situation. "When I was a young physician, we saw a woman who had a venereal disorder and it was a very clear that she got it from her husband," recalls Leonid Poretsky, M.D., an endocrinologist at Beth Israel Medical Center, in New York City. "She kept asking, 'But where could I have gotten it?' And we kept repeating, 'You can only get it from sexual contact.'" It finally dawned on her and she accused her husband right in front of Dr. Poretsky. "His faced changed colors multiple times," he remembers. Had she asked, "Is there something else you need to tell me?" they would have laid it out. Other broken-record replies that may be veiled hints? "It's a side effect of crack," "It's the kind of fracture a frying pan would make," and "It couldn't have gotten up there that way."


Scribbled in your medical records in nearly illegible scrawl: "Patient is poorly compliant and poor historian."
This could mean: "You're going to have a hell of a time finding a new doctor." If you see these incriminating words scribbled in your medical records, consider dabbing them with Wite-Out. "The most damning phrase of all is poorly compliant," says Mehmet Oz, M.D., coauthor of You: The Smart Patient. It means you're argumentative, or won't take any advice, or otherwise a huge pain. Poor historian means you offer no helpful details when asked (and can also hint that you're not genius material). Egodystonic is another common culprit; it suggests that a problem is psychosomatic because a patient secretly hated himself (perhaps for fantasizing about the gym teacher.) When switching doctors or seeing a specialist, you can request a copy of your medical records so you can hand them over yourself -- after reviewing them. It might be useful for a new physician to know that you're "non-compliant," but not if he slams the door in your face.


Medically Speaking vs. Doctor-speak translation


"This minimally invasive procedure doesn't give good exposure."
"I won't be able to see what I'm doing."


"If none of those complications occur, you'll be fine."

"I'll be fine. If everything goes well, you'll be in pain for months."


"Your blood pressure is about average."
"It's 140/90 mm/Hg, which is technically normal, but high enough so I won't be surprised if you develop heart disease."


"Your creatinine levels are a little abnormal."
"Due to your high blood pressure, your kidney is dead and this is your last chance."


"There were some iatrogenic complications."
"We caused those problems."


"We have two surgical options here, so you need to make a decision."
"Both options have a lot of drawbacks.”"


"I'll be back in a few minutes."
"Poke your head out of the door inquisitively in about an hour.”"

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