Managing Patient Uncertainty
How comfortable are we with uncertainty? I struggle with this question every day. I treat children with abdominal pain. Some of these children suffer with crohns disease, eosinophilic esophagitis, and other serious problems. Some children struggle with abdominal pain from anxiety or social concerns. I see all kinds.
But kids are tricky, and sometimes I can’t pinpoint the problem. Trudging forward with more testing is often the simplest option since it involves little thinking. And some parents perceive endless testing as “thorough.”
The question ultimately becomes: When do we stop? Once we’ve taken a sensible first approach to a child’s problem and judged that the likelihood of serious pathology is slim, when and how do we suggest that we wait before going any further? This requires the most sensitive negotiation. It’s about finding a way to make a family comfortable despite the absence of absolute certainty. This is easier said than done. Parents can unintentionally advocate for themselves and their worries by insisting on the full-court press. Alternatively they may refuse invasive studies when absolutely indicated.
All of this is for good reason: You can’t be objective with your own kids.
Pediatrics is tricky business and managing parental uncertainty is perhaps my biggest preoccupation. As I’ve suggested before, sometimes convincing a family to do less represents the most challenging approach.
*This blog post was originally published at 33 Charts*
As a med mal broker and consultant who works daily with physician clients seeking guidance in how to address issues like this from a liability standpoint, this perspective is invaluable. Posting specific information through blogs on sites like http://www.equotemd.com help us aid various physicians looking for advice in how to avoid adverse risk in treating patients, but this post gets to the root of one of the most invaluable risk management tools. Most of the time, a child is the one person a parent will have more concern for than anyone else, including themselves, and that concern leads to a greater dependence on the treating physician. Many doctors who understand communication and sincere concern carry more weight than defensive medicine (or a “I’m the expert who knows what’s best so just trust what I say” attitude) are the same doctors who can put themselves in the 35 – 50% category of physicians who are never sued for malpractice in their career. Dr. Vartabedian sums it up best in his closing statement by saying “managing parental uncertainty is perhaps my biggest preoccupation.” Teaching physicians how to adopt this attitude is a necessary factor in true reform.