# Should doctors be more blunt with patients? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [September 20, 2014, 3:11am UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998 "2014-09-20T03:11:56Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![RivkahChaya](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rivkahchaya/32/8919_2.png) [@RivkahChaya](https://boards.straightdope.com/u/RivkahChaya)\ **Post date:** [September 20, 2014, 2:03pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/21 "2014-09-20T14:03:22Z")
One of my cousins who is a doctor says it’s really hard to get it through some people’s head that you have to take ALL of an antibiotic prescription. He says he can’t tell you how many times he’s seen people back in six weeks with a much worse infection than they had before, that should have cleared up, because they stopped taking their antibiotic when they felt better. Blunt doesn’t work, scare tactics don’t work, academic lectures don’t work, because some people have their minds made up that they are going to do something before the doctor even opens his mouth. ---
**Author:** ![monstro](https://avatars.discourse-cdn.com/v4/letter/m/ba9def/32.png) [@monstro](https://boards.straightdope.com/u/monstro)\ **Post date:** [September 20, 2014, 2:22pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/22 "2014-09-20T14:22:09Z")
> [@RivkahChaya](#): > > One of my cousins who is a doctor says it’s really hard to get it through some people’s head that you have to take ALL of an antibiotic prescription. He says he can’t tell you how many times he’s seen people back in six weeks with a much worse infection than they had before, that should have cleared up, because they stopped taking their antibiotic when they felt better. Blunt doesn’t work, scare tactics don’t work, academic lectures don’t work, because some people have their minds made up that they are going to do something before the doctor even opens his mouth. This proves that bluntness and scare tactics don’t work all the time. But I’d like to think it works on those who respond well to bluntness and scare tactics (like me). But of course on stubborn ole mules, nothing works. > [@Lamia](#): > > But the mother said she wasn’t physically capable of doing the stress test, not that she just didn’t feel like doing it. Some people are just lazy though. Other people don’t know what they are capable of doing. Or they are in immense pain and can’t imagine doing a stress test without enduring even more pain, so they say they can’t do it. I don’t think a doctor should automatically trust their patient knows better than they do. But I don’t know how a doctor can push a patient to do something they don’t want to do without coming across as a jackass. So I can see how the doctor was in a no-win situation. ---
**Author:** ![LibrarySpy](https://avatars.discourse-cdn.com/v4/letter/l/f9ae1b/32.png) [@LibrarySpy](https://boards.straightdope.com/u/LibrarySpy)\ **Post date:** [September 20, 2014, 2:52pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/23 "2014-09-20T14:52:43Z")
> [@rivkahchaya](#): > > Blunt doesn’t work, scare tactics don’t work, academic lectures don’t work, because some people have their minds made up that they are going to do something before the doctor even opens his mouth. Truth. My mother was just on antibiotics, and she stopped taking them. Despite a strong understanding of how antibiotics work, and the reasoning behind them, and the threat of a massive infection near her brain. “But my stomach hurts.” So she’s a special exception. :rolleyes: ---
**Author:** ![elbows](https://avatars.discourse-cdn.com/v4/letter/e/b3f665/32.png) [@elbows](https://boards.straightdope.com/u/elbows)\ **Post date:** [September 20, 2014, 3:15pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/24 "2014-09-20T15:15:16Z")
And often, human beings, when placed in traumatic circumstances have a tendency to focus on small details of sometimes lesser import rather than actually address the obvious. **Grude** has made no secret of how difficult her Mom can be, and how stubbornly she refuses to hear sense, make compromises, or learn even the simplest things. And yet here the focus shifts to nitpicking the Dr’s phrasing while seemingly ignoring the Mom’s reticence to do anything the Dr requests. As though the outcome here was caused by the Dr being less than direct (which he wasn’t!), rather than the patient being unwilling to participate. You’ve posted so much about your family’s frustrating inability to get your Mom to do anything she doesn’t feel to, that I’m surprised you expect a Dr to magically be able to get through. She clearly doesn’t want to do any of the things he suggested and it doesn’t seem a Dr’s job to press someone into something if they aren’t willing, when his waiting room is probably full of those who are. ---
**Author:** ![bobkitty](https://avatars.discourse-cdn.com/v4/letter/b/c67d28/32.png) [@bobkitty](https://boards.straightdope.com/u/bobkitty)\ **Post date:** [September 20, 2014, 3:44pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/25 "2014-09-20T15:44:04Z")
> [@elbows](#): > > She clearly doesn’t want to do any of the things he suggested and it doesn’t seem a Dr’s job to press someone into something if they aren’t willing, when his waiting room is probably full of those who are. This. So much this. The former Mr Kitty was denied acceptance to the transplant list the first time he went through testing, and briefly taken off it when he was accepted, because he had this bull-headed belief that he knew better than the doctors when it came to his treatment (and it was exactly this that killed him in the end). Doctors at this level (and at the level the OP is talking about) aren’t interested in coddling patients who aren’t clearly on board with everything they’re being asked to do. A transplant team wants to be able to say ‘jump’ and the patient starts jumping before asking ‘how high?’… they’re just not going to take on a patient who is cagey or doesn’t listen well. It’s not about how blunt the doctor is/needs to be; it’s about the patient’s ability to listen. ---
**Author:** ![CrazyCatLady](https://avatars.discourse-cdn.com/v4/letter/c/dfb087/32.png) [@CrazyCatLady](https://boards.straightdope.com/u/CrazyCatLady)\ **Post date:** [September 20, 2014, 4:49pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/26 "2014-09-20T16:49:39Z")
> [@grude](#): > > This shocked even my sister, my mom thought the comments about having a long and fruitful life meant he thought she was worth saving with surgery, and thought him asking her to do a stress test and mall walking was just general health recommendations like eat more veggies. If your mother and sister both honestly thought an oncologist/surgeon wanted to do a _pre-op_ stress test just for her general health improvement/shits and giggles, the problem doesn’t lie with the doctor. No doctor tells you they want testing before you have surgery just because. “Eat more veggies” type of testing/advice can wait until after your very risky, potentially life-saving surgery, ya know? Also, whenever anyone in any profession anywhere talks about someone having had a long and fruitful life, that means they’ve _had_ said life, not that they’re going to have it in the future. It’s a comment you make when mitigating the sadness of someone dying. I’m sorry about your mom, but this isn’t the doctor’s fault. ---
**Author:** ![grude](https://avatars.discourse-cdn.com/v4/letter/g/e47774/32.png) [@grude](https://boards.straightdope.com/u/grude)\ **Post date:** [September 20, 2014, 7:08pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/27 "2014-09-20T19:08:41Z")
Guys this thread isn’t about blaming the doctor, I made very clear that I didn’t. It was an example of ambiguous language, which I have been messed up by myself many times in life. So I could very well see myself getting confused by a indirect, coddling doctor. And I am sure it has happened to others, it isn’t about blaming a doctor for my mothers situation, it is about making sure patients understand what is going on. I guess I don’t understand why a doctor would not make sure everyone is on the same page, it seems to me like the basic function of a medical pro. I gave some examples just as a jumping off point for discussion. Oh and you can’t tell me people in their 70s who don’t even know how to turn on a computer are rare. I would like robot like direct instructions, something like before we even consider the surgery you must do A, and B, and finally C. And if you don’t it won’t happen. ---
**Author:** ![grude](https://avatars.discourse-cdn.com/v4/letter/g/e47774/32.png) [@grude](https://boards.straightdope.com/u/grude)\ **Post date:** [September 20, 2014, 7:12pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/28 "2014-09-20T19:12:19Z")
> [@CrazyCatLady](#): > > If your mother and sister both honestly thought an oncologist/surgeon wanted to do a _pre-op_ stress test just for her general health improvement/shits and giggles, the problem doesn’t lie with the doctor. No doctor tells you they want testing before you have surgery just because. “Eat more veggies” type of testing/advice can wait until after your very risky, potentially life-saving surgery, ya know? > > Also, whenever anyone in any profession anywhere talks about someone having had a long and fruitful life, that means they’ve _had_ said life, not that they’re going to have it in the future. It’s a comment you make when mitigating the sadness of someone dying. > > I’m sorry about your mom, but this isn’t the doctor’s fault. My mom is such a whacko I wouldn’t even have believed her if my sis wasn’t there to confirm he didn’t stress that it was a requirement, and that he still made it seem like surgery was a go. And it was just an example, I found the topic interesting. In my own life if something important is at stake and I’m not sure why something is being said I just ask flat out is this required or optional etc. ---
**Author:** ![dracoi](https://avatars.discourse-cdn.com/v4/letter/d/90db22/32.png) [@dracoi](https://boards.straightdope.com/u/dracoi)\ **Post date:** [September 20, 2014, 7:29pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/29 "2014-09-20T19:29:52Z")
I’m an accountant and not a doctor, but I think I can sympathize with doctors on the fact that some people simply refuse to hear what you tell them, no matter how you tell them. Last year in October a guy comes in with what he says is an S Corporation. I point that S Corporation returns, with extension, are due in September. It’s only personal returns with an extension to October. Did he file an extension for the corp? Did he even file an S Election? He doesn’t even know what those are. OK, I explained, since he failed to file either of those things by March, I’ll do a late election under a special procedure the IRS allows. He should expect two very important letters: 1) a confirmation/denial of the late election and 2) a bill for penalties of about $1400, since no extension was filed. We would try to abate the penalties, but we can’t request an abatement until after the assessment letter is received. Two month go by. We call to ask if he got those in January. We call again in March. No response either time. Now he comes in last week… once again, he’s come in after the deadline for his corporate returns. He says “But extensions are good until October? What’s an S election? I was supposed to expect letters from the IRS? What do you mean they might assess penalties? You never told me any of this.” Oh, I told him all right. And I told his wife and I told his mother-in-law. So my guess is that this client of mine would be posting the same exact things that grude is and I would have to tell him that he’s just plain wrong. No amount of communication on my part would have made any bit of difference with a client who will not listen and who will not even ask questions to make sure he understands. ---
**Author:** ![ENugent](https://avatars.discourse-cdn.com/v4/letter/e/4af34b/32.png) [@ENugent](https://boards.straightdope.com/u/ENugent)\ **Post date:** [September 20, 2014, 8:03pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/30 "2014-09-20T20:03:35Z")
> [@dracoi](#): > > I’m an accountant and not a doctor, but I think I can sympathize with doctors on the fact that some people simply refuse to hear what you tell them, no matter how you tell them. > > Last year in October a guy comes in with what he says is an S Corporation. I point that S Corporation returns, with extension, are due in September. It’s only personal returns with an extension to October. Did he file an extension for the corp? Did he even file an S Election? He doesn’t even know what those are. > > OK, I explained, since he failed to file either of those things by March, I’ll do a late election under a special procedure the IRS allows. He should expect two very important letters: 1) a confirmation/denial of the late election and 2) a bill for penalties of about $1400, since no extension was filed. We would try to abate the penalties, but we can’t request an abatement until after the assessment letter is received. > > Two month go by. We call to ask if he got those in January. We call again in March. No response either time. > > Now he comes in last week… once again, he’s come in after the deadline for his corporate returns. He says “But extensions are good until October? What’s an S election? I was supposed to expect letters from the IRS? What do you mean they might assess penalties? You never told me any of this.” > > Oh, I told him all right. And I told his wife and I told his mother-in-law. > > So my guess is that this client of mine would be posting the same exact things that grude is and I would have to tell him that he’s just plain wrong. No amount of communication on my part would have made any bit of difference with a client who will not listen and who will not even ask questions to make sure he understands. Did you send him a letter with that info? If you didn’t, you might want to change your general practice in this respect. It’s a lot easier to deal with the second interaction when you can lay your copy of the letter in front of him and tell him, “Not only did I tell you all of this last year, I notified you in writing, as you can see here.” Safer than relying on having told his mother-in-law. (I acknowledge there may be reasons I don’t know for not putting it in a letter. But I can’t think of any.) Doctors should be blunt, but [not cruel](http://www.washingtonpost.com/national/health-science/fat-shaming-obese-people-may-actually-cause-them-to-gain-weight-a-study-suggests/2014/09/15/2e22e256-39bb-11e4-bdfb-de4104544a37_story.html). I acknowledge that it can be a tough line to draw. ---
**Author:** ![RivkahChaya](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rivkahchaya/32/8919_2.png) [@RivkahChaya](https://boards.straightdope.com/u/RivkahChaya)\ **Post date:** [September 20, 2014, 8:09pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/31 "2014-09-20T20:09:13Z")
What does this mean? > [@](#): > > A study published last year found that people \*\*\*who are not obese \*\*\*who experience weight discrimination are 2.5 times as likely to become obese a few years later as are those who do not experience weight discrimination. [emp. added] Does that mean that people who experience discrimination for being too skinny put on a few pounds as well? Or are they talking about people who are perceived as a little chubby, but are not medically obese? ---
**Author:** ![ENugent](https://avatars.discourse-cdn.com/v4/letter/e/4af34b/32.png) [@ENugent](https://boards.straightdope.com/u/ENugent)\ **Post date:** [September 20, 2014, 8:54pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/32 "2014-09-20T20:54:16Z")
> [@RivkahChaya](#): > > Does that mean that people who experience discrimination for being too skinny put on a few pounds as well? Or are they talking about people who are perceived as a little chubby, but are not medically obese? I would assume both. ---
**Author:** ![elbows](https://avatars.discourse-cdn.com/v4/letter/e/b3f665/32.png) [@elbows](https://boards.straightdope.com/u/elbows)\ **Post date:** [September 21, 2014, 12:06am UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/33 "2014-09-21T00:06:30Z")
What he spoke was clear and direct enough for any adult. Nothing seemed imprecise in the slightest. He cannot be faulted for them not getting it AND not speaking up. Why would he need to use short sentences and repeat himself when there’s a second adult present? If, between the two of them, they can muster neither understanding of what was clearly stated, nor the questions that would have provided them with clarity that’s not really the fault of him speaking precisely, as I see it. ---
**Author:** ![dracoi](https://avatars.discourse-cdn.com/v4/letter/d/90db22/32.png) [@dracoi](https://boards.straightdope.com/u/dracoi)\ **Post date:** [September 21, 2014, 12:52am UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/34 "2014-09-21T00:52:40Z")
> [@ENugent](#): > > Did you send him a letter with that info? If you didn’t, you might want to change your general practice in this respect. It’s a lot easier to deal with the second interaction when you can lay your copy of the letter in front of him and tell him, “Not only did I tell you all of this last year, I notified you in writing, as you can see here.” Safer than relying on having told his mother-in-law. (I acknowledge there may be reasons I don’t know for not putting it in a letter. But I can’t think of any.) Yeah, there are parts of it that were written (well, e-mailed) as followups to phone calls or in-person meetings. In fact, part of our practice on any reminder call is to e-mail a written version of anything that we don’t receive during the call. I’m actually cutting the story to its essentials to keep it on point as a response to the OP or there’d be a lot more to fill in some gaps. But it’s actually a quite common story. Another client we went back and forth for six months with reminder e-mails saying “Here’s a list of things we need” and they’d reply, quoting our e-mail, with “OK, thanks. What do you need?” ---
**Author:** ![aruvqan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aruvqan/32/2891_2.png) [@aruvqan](https://boards.straightdope.com/u/aruvqan)\ **Post date:** [September 21, 2014, 1:06am UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/35 "2014-09-21T01:06:29Z")
> [@Lamia](#): > > I’m not seeing the problem here. Your mother said she was too weak to walk on a treadmill or even walk at the mall, and the doctor concluded from this (and presumably the other information he had about her age and health) that she was too weak to survive the surgery. I’m not a doctor myself so I don’t know if this is a reasonable conclusion to draw, but he presumably wasn’t refusing to perform the surgery out of sheet spite. If your mother was too weak to do the stress test then she wouldn’t have been helped by the doctor pressuring her into trying anyway, as the end result still would have been him refusing to do the surgery on a patient he didn’t think would survive it. Scuse me? Run her into imaging and do a chemical stress test. Easy peasy. Screw that doc for being lazy. > [@Claverhouse](#): > > In previous times doctors in Germany were obliged to offer a glass of champagne to anyone they were telling their status was changed to dying. > So hearing a cork pop would not always thrill one. Beats the hell out of being asked if I knew anybody who would come stay with me for the week until mrAru got shipped back from deployment and the scrip for valium when I got dx with a tumor and scheduled for surgery 1 week later. Though I prefer asti spumante… [URL=“[http://www.pinterest.com/pin/create/extension/](http://www.pinterest.com/pin/create/extension/)”] ---
**Author:** ![drachillix](https://avatars.discourse-cdn.com/v4/letter/d/48db29/32.png) [@drachillix](https://boards.straightdope.com/u/drachillix)\ **Post date:** [September 21, 2014, 1:59am UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/36 "2014-09-21T01:59:06Z")
IWNAD but I was an EMT. A huge cross section of people do not want blunt, they want you to hold their hand, tell them its going to be OK, and send them off to do whatever they damn well please anyway. People also lie to medical personnel all the time. Doc: Did you take your diabetes medications Patient: yes Doc: did you obey your food plan Patient: yes Doc: Hmm your a1c implies otherwise Patient: how dare you call me a liar, im gonna find a new doctor Patient: Its probably because you gave me the wrong medications or bad instructions Patient: Stomps out This is where applying a “customer is always right” attitude to medicine may not serve the best interest of the patient, but it often is what the public demands. Some medical folks will indulge some of the posturing and non compliance to slowly work to educate and or adjust a medication regimen to help compensate for poor compliance. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [September 21, 2014, 2:07am UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/37 "2014-09-21T02:07:35Z")
It’s really hard. In addition to the problems already mentioned (people taking offense, people not listening and remembering accurately, doctors not giving decent written education materials to be reviewed later), you’ve also got the problem that a surprising number of people don’t \*want \*blunt. I want blunt, and a lot of information. You want blunt and a lot of information - I bet most of the members of the SDMB want blunt and a lot of information. We’re a curious bunch here, or we wouldn’t be here. But it’s a mistake to think that everyone wants blunt and a lot of information. As hard as it is for us to believe it, a whole lot of people don’t. They want to know what’s “important” to know, but they don’t want icky details, and they really, really don’t want to hear a straight up blunt description of what’s going on or any blunt indication that their behaviors and choices are killing them. I’ve (as a nurse, not a doctor) had to have a few “come to Jesus” talks with patients and their families. Half the time, the shadow lifts, the light dawns and I see, if not a change in behavior, at least an acceptance that these things (diet, lifestyle, medication compliance) are indeed _choices_, and that they are having an effect. Then at least they stop blaming their doctors and nurses for their condition. About a quarter of the time, there’s just no change whatsoever. They either don’t remember or don’t believe what I’m saying. One quarter of the time, I end up with an angry patient who digs their heels in and \*intensifies \*the maladaptive behavior. \*That’ll show me. \* Overall, I still stand by patient education and autonomy as my most important professional goals, but the more patients I’m exposed to, the more I understand why so many nurses and doctors don’t tell their patients anything. They’re tired of being yelled at, misunderstood and ignored. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [September 21, 2014, 2:10am UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/38 "2014-09-21T02:10:55Z")
> [@drachillix](#): > > This is where applying a “customer is always right” attitude to medicine may not serve the best interest of the patient, but it often is what the public demands. Some medical folks will indulge some of the posturing and non compliance to slowly work to educate and or adjust a medication regimen to help compensate for poor compliance. You may like this. It’s satire, but barely. [Patient Satisfaction Survey Study Halted; Mortality Increased 238% with Patient Satisfaction](http://www.gomerblog.com/2014/08/patient-satisfaction-2/) ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [September 21, 2014, 2:59am UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/39 "2014-09-21T02:59:46Z")
> [@drachillix](#): > > Doc: Did you take your diabetes medications > Patient: yes > Doc: did you obey your food plan > Patient: yes > Doc: Hmm your a1c implies otherwise Oh, HI, I didn’t know you knew my Mom! My sister in law is a doctor. She, like Mom’s doctor, was very worried because Mom’s glucose numbers kept not getting better enough, until I took SiL and Mom’s little glucose notebook and showed her when the bad numbers happened. According to Mom, two tapas (half a boiled egg with mayo, tuna, chopped up veggies, a pimiento olive; three breaded shrimp) and a glass of white wine (Sunday after Mass; before lunch), or an iced, glazed bun and a cup of coffee with milk and saccharine (Tuesdays when she goes out with her friend Adriana, also diabetic; before dinner) do not count as meals, you see. ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [September 21, 2014, 3:46am UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/40 "2014-09-21T03:46:14Z")
> [@Jackmannii](#): > > I think I’ve mentioned my champion example of M.D. bluntness here before. > > In med school I accompanied an E.R. doc into an exam room to see a morbidly obese young woman who was there for a relatively trivial complaint. He examined her, described what the problem was and how it could be handled on a non-emergency basis. He then told her “You need to eat less” - and walked out of the room. > > Yes, we need more direct interactions like that from our medical professionals and less sugar-coating. :dubious: This doctor crossed the line from “blunt and factual” into “asshole in a lab coat with a degree.” Telling someone “You need to eat less” and leaving the room is easy. Going into the icky details about the patient’s life and medical condition is hard. I expect hard truths, hard work, and icky details to go both ways in a doctor-patient relationship. [Previous page](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998.md?page=1) [Next page](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998.md?page=3)