Sunday, April 27, 2008


The following is a scene from one of my favorite movies, Reservoir Dogs. Two guys are driving frantically to a rendezvous point after a botched bank robbery. Mr. Orange, covered in blood, has been shot in the belly and is bleeding to death. Mr. White, an accomplice, is driving and trying to keep his partner calm.

Mr. Orange: [crying, bleeding from a gunshot wound] All this blood is scaring the shit outta me, Larry! I'm gonna die, I know it!

Mr. White: Oh excuse me, I didn't realize you had a degree in medicine. Are you a doctor? Are you a doctor?

Mr. Orange writhes in pain.

Mr. White: Answer me please, are you a doctor?

Mr. Orange: [in pain] No, I'm not...

Mr. White: Ahhhh, so you admit you don't know what the fuck you're talking about. So if you're done giving me your amateur opinion, lie back and listen to the news...
I like that last line said by Mr. White.

It's not unusual to have a patient come to the office thinking they're going to undergo/receive a specific treatment for whatever is ailing them. It is, however, quite unusual for them to have the correct treatment in mind. So when I tell them what I plan to do, they're caught a little off guard.

I expect questions from the patient to clarify and elucidate the treatment and how it will help them. And I am more than happy to spend the time explaining everything. But strangely, there are a few people that will argue with me about my treatment plan. "I don't think that's going to work."

"Oh really? Based on what?" I want to ask.

A Google search? Really? They're going to argue with me based on what they found on the internet? I don't care what they've found with a Google search. Unless Google's got a medical degree and finished a residency training program, I'm not interested.

Intuition? I'm all for going with your gut feeling, but I'm not trying to sell you a used car. There are lots of places appropriate for debating and bargaining. I just don't see how asking a surgeon to compromise on something is the best way to go. Especially when it comes to your own body.

I'm not the guy trying to trick you into an unnecessary major brake overhaul when you came in just to get your oil changed.

It's terribly frustrating to get that obstinate patient in the office that comes with preconceived notions of what they need and only wants XYZ treatment done instead of the more appropriate ABC that I think is the best. And for some reason, they refuse to back down and accept that my idea is the superior choice.

My plan is based on formal medical training, science, and the experience of many surgeons before me. Their plan is based on... something not as substantial. One day, it would be so refreshing to be able to say what Mr. White said up there.

"...if you're done giving me your amateur opinion, lie back and listen to the news..."

With medicine, once you take on the responsibility of operating on somebody, you're stuck with them for the rest of your/their life. And I don't want to have to spend the next 20 years of my career stuck taking care of this argumentative, obstinate, ignorant pain-in-the-butt. I'd rather pass this patient down to another surgeon.

So those visits often end with me saying "You're free to go get a second opinion. Here's a list of other surgeons..."