Disagree with Your Doctor? Respectfully Explain Why
I love my readers for so many reasons, but one of them is that they leave intelligent and interesting comments on my posts. This one caught my eye:
. . . in my experience anytime you challenge a p-doc they try to attribute it to a symptom such as paranoia or delusions of grandeur. So my question is how to talk back to a doctor when you don't agree with him if you are as knowledgeable as you obviously are without that happening or is it a lost cause?
(Ever think a doctor has delusions of grandeur? Just saying...)
I do not think it's a lost cause. I talk to my doctor like a colleague all the time, but it is tricky.
When You're Smarter Than Your Doctor
Well, OK, I don't know whether I'm "smarter" than most doctors but I am more informed. Recently I asked about a supplement that has promising study behind it and no one in the psychiatry department had ever heard of it.
Consequently, the doctor rather wrote it off. Which wasn't acceptable to me. So I brought in the study information and we discussed it. I can't say she jumped onboard, but she did find some information for me which allowed me to make a decision about it.
I Bring the Evidence
So I think there are two keys to what happened:
- I approached the subject softly, deferring to the doctor's authority
- When I wasn't happy, I brought in hard science
So first off, I think it's important to let the doctor know you respect him (or her) and respect his education. He did go to a lot of trouble to get it, after all, and no matter what you do, you are never going to have the background knowledge of a psychiatrist (unless, you know, you are one).
And this means being kind to their ego. No matter how right you think you are, you might not be, so it's about engaging the doctor in conversation and not about convincing him you're right. If you're right, the conversation will bear that out.
Secondly, if you're not happy with the outcome, don't get mad, get even. Has he facts? You get some facts too. Bring in printed material to discuss. If you disagree, there must be a reason why you disagree so you have to explore that. Get the doctor to fully explain his reasoning. He may know something that overrides your research. That's OK. That's what talking to him is all about.
Why or Why Not? That is the Question
Because I think differing opinions come down to fully expressing why they are held. Why do you think the way you do? Why does he think the way he does? Can you come to an understanding? Can you compromise? Should you defer to his knowledge?
Now it's true, the doctor may not want to fully explain why they feel the way they do.
As long as you're paying them, that's their job. It's their job to explain themselves. It's their job to answer your questions. They work for you.
Understanding that, it is your job to be professional about it. You can't throw a fit just because they disagree. You have to work with them, not against them. Try what they want and evaluate the outcome. Don't disagree just because you can. This is a relationship you're building. Treat it with care. And over time it will become easier as the doctor comes to trust you and your opinion more.
Tracy, N. (2011, September 20). Disagree with Your Doctor? Respectfully Explain Why, HealthyPlace. Retrieved on 2023, February 2 from https://www.healthyplace.com/blogs/breakingbipolar/2011/09/disagree-with-your-doctor-respectfully-explain-why
Author: Natasha Tracy
Last time I went to my Nurse Practitioner Psychiatrist, I asked for my records so I would have a copy. With that she labeled me as untrusting and paranoid, and changed my diagnosis from clinically depressed to schizophrenia. This made me realize that she may be the paranoid one and I am considering changing doctors as a result.
" I think those guys, if you have the option, are best left to torture other patients while you find yourself a decent doctor."
I couldn't agree more.
This is a great article. I often have discussions with my doctor and we have agreed upon this: I'm really smart, well informed, and as he has pointed out, I am the expert on ME. He is also really smart (my own opinion), also well informed although about different things, and as he pointed out, he has experience and knowledge that I don't have - how the "general population" responds to different treatment. He takes me at my word when I say "I've had this reaction to x medication in the past" and I understand that he knows more about the world in general than I do and our sessions are usually a good two-sided discussion about my treatment. I think it's borne out of mutual respect and trust. And I have to laugh, because before reading this, I had printed out (and highlighted parts of) and article about the HPA axis to bring to my next appointment.
I wish all doctors were like this one. Some just have total ego and self esteem problems and not only refuse to read what you bring in but also dismiss objectively measurable side effects (an example from my own life - resting pulse averaging above 130 after starting a medication with tachycardia listed as one of the most likely side effects) as "all in your head" without even bothering to see for themselves. I think those guys, if you have the option, are best left to torture other patients while you find yourself a decent doctor.
Hi Dr. George,
Nice to hear a doctor's voice in the discussion.
I can definitely see where self-diagnosis is frustrating for a doctor. It's frustrating for me too, and I'm just a writer :) I always tell people they need a professional evaluation and diagnosis and self-diagnosis is never appropriate.
It's good you've learned to handle it well, so we can all benefit.
I would tend to disagree that a diagnosis matters little. True, I care much more about getting rid of my symptoms than I do about a label but without that label, research and treatment becomes much more difficult if not impossible. Far too many people with bipolar disorder are treated improperly with antidepressants for just this reason.
Actually, I think doctors wanting to work alone is one of the problems in the medical field. When they don't want to, it makes me think they are doing something wrong and they don't want anyone to find out, or, heaven forbid, question their judgement. And, if you need emergency services, then obviously you _need_ emergency services and politics shouldn't enter into that.
You're welcome :)
I work as a family practitioner with a strong focus on mental health and mens health.
I have to admit one of the patient presentations I find frustrating is when someone turns up and states they are suffering with "diagnosis x" say for example conjunctivitis.
The problem is that I can never be sure that what I have in my mind as conjunctivitis is the same as my patients.
For this reason I usually respond with something like, Ok, seems like you have done a bit of research into this, just to make sure we are on the same page, can you tell me about the symptoms you have been having?
This enables me to get back to the physical symptoms and enables me to make sure it is what the patient describes plus exclude more dangerous things that are not always so obvious.
I think as family practitioner I do this more frequently so P-docs can sometimes get a bit huffy when they are told of diagnosis x or y.
For me in psychiatry we are treating symptoms, so the diagnosis while it's nice to have, making sure the symptoms are fully addressed is more important.
This is a great article - and unfortunately it is one that needed to be written.
My personal experience is I have a regular doctor (called a General Practitioner here) at my medical centre who is particularly trained in psychiatric medicine. In many ways he is very astute and I particularly like his pragmatic approach and realisation that some patients need the spiritual side of what they are experiencing recognised. He has always let me decide which options to take. However, he clearly has some kind of political issue with the psych team at the hospital and was not happy that twice I went to emergency psychology services. I actually needed to go both times and one time it prompted a necessary medication change.
My doctor, I think, likes to work alone and not have others involved in his patients' cases. At least not the hospital psychiatrists. It's slightly dangerous but I am aware of it and manage around it. When I wasn't thinking clearly I was lucky to always have my husband or mother with me as an advocate.
Because I'm somewhere around Bipolar II/Emotional Instability I know that my judgement isn't quite correct at times so I do listen to my doctor as well. To get that diagnosis (instead of just depression/anxiety) he did refer me to a specialist psychiatrist at our community mental health service. Apparently he is happy to work with them.
Sadly in all areas of medicine (in my country anyway) there are people with egos and there are politics. This sort of thing should never impact on patient care but it does so we have to trust the professionals, but definitely not blindly.
Thanks Natasha :)
You're welcome :) I was looking for a topic and you handily provided. I'm always happy to address a topic of interest.
Thanks for addressing my comment! It really does make a difference if you have a strong enough relationship with your doctor over time so the advice is appreciated!