# 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:** 5\ **Page:** 4
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [September 22, 2014, 7:01pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/61 "2014-09-22T19:01:23Z")
> [@RivkahChaya](#): > > Cripes, that makes sense! I have IBS, and sometimes when I get stuck in a smokey room (which fortunately happens rarely now) I feel nauseated, the way I do before a bad case of the runs (I get nausea predictably about 4-6 hrs before an especially bad case of the trots). I know to take medication, so I can head off the attack sometimes, but I still have the nausea. People told me it was psychosomatic, because I was anticipating the allergic reaction where I get itchy, and burning skin, runny eyes and nose, and general unpleasantness. Yep, it’s not in your head. It’s in your gut. You sensitive to nightshades (tomatoes, potatoes, eggplant) too? Those have nicotine or a very similar alkaloid in them as well (as does cauliflower). Very common IBS triggers, especially if eaten in large quantities. It takes about 20 pounds of eggplant to equal the nicotine of a single cigarette, but if your gut is particularly sensitive to nicotine, it can cause issues. ---
**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 22, 2014, 7:50pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/62 "2014-09-22T19:50:30Z")
> [@WhyNot](#): > > Yep, it’s not in your head. It’s in your gut. > > You sensitive to nightshades (tomatoes, potatoes, eggplant) too? Those have nicotine or a very similar alkaloid in them as well (as does cauliflower). Very common IBS triggers, especially if eaten in large quantities. It takes about 20 pounds of eggplant to equal the nicotine of a single cigarette, but if your gut is particularly sensitive to nicotine, it can cause issues. I don’t like eggplant. I love tomatoes, but I can’t eat them on an empty stomach. I eat them in sauces along with pasta, or other things that tend to work well as “binders.” I love salad, but I can’t eat a lot of it. I always thought it was the vitamin C in tomatoes that made them hard on the gut. Potatoes I do pretty well with, but that’s because they have so much starch, and starch is really good for me, like I said. I have a fairly mild case of IBS, but I have to keep Immodium on hand the way some people have to keep ibuprofen or Benadryl in the medicine case. Some people’s symptoms border on Crohn’s or Celiac disease; I’m not nearly that bad. ---
**Author:** ![robert\_columbia](https://avatars.discourse-cdn.com/v4/letter/r/e79b87/32.png) [@robert\_columbia](https://boards.straightdope.com/u/robert_columbia)\ **Post date:** [September 22, 2014, 10:22pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/63 "2014-09-22T22:22:11Z")
> [@grude](#): > > 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 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. While I’m not sure I would approve of such strict policies, I am strongly in favor of being blunt and precise. E.g. no more “You need to live a healthier lifestyle”, “Eat more vegetables!” or “Don’t stay up so late!”. Tell me what a “healthier lifestyle” involves. Are you referring to seeking greater life balance in work, fun, exercise, social interaction, study, etc. in a broad sense, or is “healthier lifestyle” a polite code word for “quit smoking”, “quit McDonalds”, “watch no more than one hour of TV a day”, “Enroll in our Healthy Living Track and Field Running Development Course”, or “Follow the Kansas Department of Heath’s Diet Guide and the nutritional and portion size messages found therein that hath been inscribed thereupon for the benefit of thineself and kindred unto the end of days, for it is your new Bible”? ---
**Author:** ![robert\_columbia](https://avatars.discourse-cdn.com/v4/letter/r/e79b87/32.png) [@robert\_columbia](https://boards.straightdope.com/u/robert_columbia)\ **Post date:** [September 22, 2014, 10:42pm UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/64 "2014-09-22T22:42:03Z")
> [@WhyNot](#): > > 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… This this this x10. And not just for medical issues too - in general. E.g. at work, don’t tell me that I have “performance issues”. Tell me specifically what the problem is. Am I not returning things quickly enough? Am I returning things promptly, but full of problems? Am I not helping others to the degree that you wanted? Am I helping others too much and contributing to a culture of laziness and “Just call robert\_columbia”? Am I using poor grammar in technical documentation? Am I not writing enough? Am I writing too much and boring customers out of their mind with needless details? Am I not stroking the boss’s ego enough? Did I fail to understand that the “Optional after-hours technical training program” is really a “requirement” because “everyone is expected to exceed expectations”? At some jobs, getting your work done early and leaving early was a “performance” problem. Dammit you were supposed to find more work, not leave! I can’t “improve my performance” unless I know what the standard is. Why won’t you tell me? ---
**Author:** ![grude](https://avatars.discourse-cdn.com/v4/letter/g/e47774/32.png) [@grude](https://boards.straightdope.com/u/grude)\ **Post date:** [September 23, 2014, 3:08am UTC](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998/65 "2014-09-23T03:08:32Z")
> [@lavenderviolet](#): > > For what it is worth (not sure if this would matter in your mom’s case),iIt is possible to do a stress test on people who can’t walk on a treadmill. If you are still at the point where your mom would want to pursue surgery, it might be worth asking if a “chemical” stress test (injecting medication to stress the heart as if you were walking) would provide enough information. > > As for the general issue you mention, I am not surprised the communication problem happened with a surgeon. Surgeons are not known in the medical world for having the best bedside manner or communication. A lot of surgeons are attracted to surgery because it is such a black and white specialty without a lot of interpersonal/social work type of stuff in it. There is something very appealing about being able to fix the acute problem then move on without a lot of chit chat or handholding for some surgeons. > > It sounds like your mother has some cognitive problems - whether those cognitive problems are from dementia, mental illness, effects of her physical illness (like uremia if her kidneys are failing) and/or just a lifetime of low IQ. > I definitely think that it is true that there are some patients who are offended by overly blunt and direct language, especially about life threatening matters. However, I agree that with someone who is not functioning well cognitively that doctors should try to be careful to make things easy to understand. It might help if in the future anyone who goes to doctor appointments with your mother tries to discreetly let the doctor/office staff know that mom has trouble with comprehension. I think it might help if the doctor knows going into the situation that it is best to be very simple and direct with her. > It might also help you to not be as frustrated with her if you try to remember that it really isn’t her choice to be like this. If her brain isn’t functioning the way it should (regardless of whether it is because of mental illness, low IQ, or physical illness) then she really can’t help that she is having a hard time understanding and behaving appropriately. She doesn’t have a low IQ per se, she just isn’t really good at picking up implied things or social cues. She has worked jobs where no one with a low IQ could have gotten by, like financial manager of a small department store chain(although this was more than 30 years ago). Additionally although she sounds like a fluent native speaker, she learned English as an adult, so she still gets tripped up by idioms and slang and round about language. I asked my sister what she thought the doctor meant, and she said she thought he was preparing my mom for the outcome of dying during the surgery due to anesthesia. That is what she thought the “long full life” thing was about. [Previous page](https://boards.straightdope.com/t/should-doctors-be-more-blunt-with-patients/698998.md?page=3)