How Should the Doctor Know?

Written by Dr. Nelson Branco

Last week, a family asked for my opinion on whether they should have a third child. Truthfully, my first instinct was “How should I know?” but of course, that’s not what I said. It’s a fair question, considering that I have three kids myself, and I know a thing or two about families and kids. But it’s a very personal decision, and one that this couple was obviously taking very seriously. After spending a few minutes giving them the most thoughtful answer I could come up with, I went on to the next patient and the next set of questions.

But the moment stuck with me because it illustrated in a concrete way that I have a special role in the lives of my patients and their families.

When I meet with parents-to-be for a prenatal visit, I tell them that I give advice, and they make decisions. I am full of advice and opinions (ask anyone) but ultimately they have to decide on bedtimes, rules, discipline, sleep training, diapers, feeding, and the many decisions to be made when you’re a parent.

When I was a kid, there were a few people whose opinion was sought out and respected because of who they were – doctors, priests and teachers. Others had to earn respect on their own merits. Times have changed, and I live in a different community than the working-class immigrant community where I grew up.

My opinions and advice have to stand on their merits, and I have to earn the respect and trust of my patients and their families.

I wouldn’t have it any other way, and neither would your pediatrician, I’m sure.

I don’t live in a particularly small town, but our community is small enough that I’m frequently recognized by patients or parents. I enjoy it, but my kids sometimes complain – “Wherever we go, you see one of your patients!”. It’s not like being a rock star, but I do have to mind my manners in public, and I’m sure to be asked to examine at least one rash if I venture out to a school event or the farmer’s market.

A few weeks ago, that didn’t work out so well. Riding home on my bike, I passed two of my patients standing on their front porch. I waved, which meant that when the the Prius (quietly) came around the bend, I didn’t have my right hand on the brake lever. Anyone who has ever ridden a bike can predict what happened next.

Too much front brake sent me flying over the handlebars.

Of course, I was wearing my helmet so I can now speak with even more authority about the importance of wearing one. Unfortunately, the helmet didn’t stop me from breaking my elbow (radial head). The person driving the Prius stopped immediately to see if I had survived. This being Marin County, the herbs and potions capital of California, she immediately offered me Arnica to apply to my wounds. I deferred. Didn’t want to delay the x-ray and pain medicine that I knew were in my future.

So the doctor became a patient, and I spent a few weeks explaining to parents why I am examining their children one-armed. I know that they appreciate that I am there, and to be honest I never considered staying home from work – who would tease me about my bike crash otherwise?

Last month, my colleague Dr. Sprayberry posted “Why Your Doctor Chose to Be Your Doctor.”  He talked about the sacrifices medical students and residents make to become doctors, and how much strain that can put on us personally, and on our families. We do it “to help people” as he puts it, but it’s much more than that. I go to work each day to listen, advise, assist and amuse. I know that I am a part of my community and of my patients’ lives because they are a part of mine. I hope you can say the same about your job. Like I said, I wouldn’t have it any other way.

Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP.

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2 thoughts on “How Should the Doctor Know?

  1. I love this post. I have three kids. Before the third when I was 37years old with one child with autism, I asked my ob/gyn about a third. I just wanted to know if my desire for another one was common to all women approaching 40. Maybe some mid-life crisis kind of thing. He listened which is really all I needed. Sadly, he was a solo practitioner and could not sustain a practice in the current health care climate….but that’s a post for another day.

  2. Thanks dr_som. Glad you enjoyed it. I think we all underestimate how important it is to just listen. Especially those of us who are used to fixing things…but that’s also a post for another day. I think many doctors of my era were influenced by the study done about 10-15 years ago that showed that physicians listen to their patients for about 16 seconds, on average, before interrupting. Takes practice, but giving people time to get all their worries out makes for better care, in my opinion.

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