* * Anonymous Doc

Tuesday, February 23, 2010

Patient in clinic today had some sort of issue that was making her very, very warm -- and for whatever reason she was wearing a very heavy sweater to the visit. She's sweating, having trouble getting through the exam-- I wanted to tell her she can take the sweater off, it's a doctor's office, it's okay, I'd rather she be comfortable than suffering, and we need to get through the exam... but I didn't. I couldn't get past the idea that I'm opening myself up to some sort of insane sexual misconduct lawsuit if I tell a female patient she's allowed to take her sweater off. If she was there with some sort of problem that required me to do a breast exam, or something like that, obviously I would do the exam. I've probably seen fifty vaginas in the past six months, it's not like this isn't a normal part of my job. But somehow the vague-ness of it -- I don't care if she took off her sweater, I didn't need her to take it off for any medical reason, it just seemed like she would definitely feel better if she did, and there was no reason not to -- it just made me feel awkward and uncomfortable. I don't know, being a doctor is strange sometimes-- we have a real power over our patients, we say things and they have authority behind them. If I tell one of my friends he shouldn't eat at Burger King because it's bad for you, he doesn't feel compelled to listen or give my opinion any weight-- but if I tell a patient, it has weight. They may not listen, but they'll feel bad if they don't listen. By virtue of wearing the white coat, I have authority. I'm still not used to it. I still find myself talking to patients sometimes like I'm a peer and not a professional. More than once, I've made a comment that's probably too casual when we're talking about running some blood work. Like, "I hope they don't find [whatever]." As a fellow human being, I hope they don't. As a doctor, am I supposed to acknowledge hope, and uncertainty? Shouldn't I say something like "there's an x% chance they'll find [whatever]," or say nothing at all, and wait until they find what they're going to find, and not scare the patient needlessly? I don't know. They don't train us (much) in actual patient interaction. We're expected to pick it up, to know things automatically. I still don't know if I should have told that patient to take her sweater off or not. And there's really no one to ask.


  1. Dont you have to be confident to be a doctor?

  2. I'm a PA in family practice, and it took me about a year to get used to being myself with my own mannerisms while wearing that white coat. I had a lot of the same thoughts that you wrote about.

    But I learned that yes, it's ok to hope for patients, and it's ok to say it out loud. In fact, it helps make you human to the patient.

    and just a hint... sometimes it helps me to have the right "lines" for uncomfortable situations... If you're going to say something awkward it always helps to preface it with: "Are you ok? You seem (really warm, upset, etc)?" The "are you ok" is always a good lead-in. Makes you seem concerned, rather than pointing out a problem.

    Keep on writing! Your blog is great!