Dealing with difficult doctors VII: the egotist

November 17, 2008  |  General

Here is another post taken from my newest book, How to Talk to Your Child’s Doctor. This one concerns what I call the egotist.

Egotism is a common trait among doctors, although most of us keep it under adequate control when dealing with patients. Throughout this book, the ideal doctor-parent encounter has been described as a collaboration among equals, each of which brings expertise to the exchange; the doctor knows medicine, the parent knows the child. This is the ideal, although sometimes the reality falls short of it. The way our medical system is now structured gives more power and influence to the doctor side of the relationship than the patient side. As you read in chapter 7, things were not always this way; a century ago a surplus of doctors with treatments of doubtful usefulness scrambled to attract patients. These days, however, physicians have many more therapies that actually work, plus the benefit of an enormous medical establishment behind them. So now doctors are usually the ones deciding who gets what treatment. In spite of that fact, good, experienced doctors will do their best to use their power over patients lightly, always inviting parents and patients to share in the authority.

Physician egotism can get in the way of good communication in several ways. A simple manifestation is the tug-of-war over whose time is more valuable, the doctor’s or the parents’. A good example of this conflict is the doctor who schedules far more patient appointments than he can accommodate in a day, then seems unaware of how keeping a parent waiting for hours can poison the atmosphere even before the evaluation has even begun. Parents usually understand long waits when they take their child to the doctor for an unanticipated acute problem. If the waiting room is full of children just like theirs, there is little the doctor can do except see them each in turn. But the subspecialist who packs his waiting room with too many scheduled patients is proclaiming, in effect, that his time is far more valuable than that of parents, who often must take off a full day’s work to bring their child to see him.

The egotistical doctor is one who tends to forget that the patient is the center of everything, the reason the parents are there in the first place. He forgets that the encounter is about the child, not the doctor. This attitude can show itself in a persistent tendency to turn the subject of the conversation away from the child and toward the doctor. The result may be harmless, as when a garrulous doctor is genuinely trying to relax the parents and their child with a friendly conversation about other things, or it may be more toxic, as when a doctor constantly talks about himself and what he does. The latter can be particularly trying to parents who have waited a long time to see the doctor, only to find their brief time with him taken up by extraneous chatter.

Although it can be annoying to parents, excessive egotism in your child’s doctor is generally a minor issue in the big picture of getting your child the evaluation she needs. I say this because, although there are exceptions to everything, for the large majority of doctors I have met who are more egotistical than the average, their self-centeredness does not get in the way of their medical skills. In fact, some subspecialties, such as high-risk surgery, almost require the physician to have a huge ego if he is to perform such surgeries effectively .

So it is largely a matter of the personal taste of the parents. If you find yourself irritated when talking with an excessively egotistical doctor, and if you think this is interfering with his proper evaluation of your child, the best thing to do is to be persistent in turning the conversation back to your child at every opportunity. Of course, if you are really irritated by his manner or the way he treats you, do your best not to see him again.


3 Comments


  1. Do you ever have to deal with opinionated GRANDPARENTS?

    My pediatricians for the five children we raised — were exclusively men who knew my family and lived in the community. We saw some of them for decades in private practice. I don’t recall any egoists per se. However, some of the fee-for-service doctors were good communicators, and others less so. I always wanted as much information as I could get.

    I recall having some second thoughts about tonsillectomies, but we ended up having two of the five children undergo the procedure. What’s the thinking about tonsils and adenoids today?

    One of the frustrations of being a grandmother is that my children think I’m no part of their family — “old and out of the picture” — and refuse to take any of my advice. I’ve had some things to say to them over the years, but my opinions are certainly not sought after.

    This started with some subtle suggestions I made to my daughter about how she was handling her first infant in 1998. (We live in the same city.) One day, she flared at me, “I WAS BORN 30 YEARS AGO, MOM. EVERYTHING HAS CHANGED. DON’T TELL ME WHAT TO DO BECAUSE I WILL ONLY LISTEN TO MY PEDIATRICIAN…”

    Over the years, I’ve had thoughts about my granddaughter’s excess weight and early maturation, as well as my grandson’s enuresis, eternal rhinitis, and worries about retracted testes. I get ignored on pretty much everything.

    Maybe I’m too involved — and too well-trained in medical malpractice and worker’s compensation investigations. I’m always reading about new treatments and drugs.

    As for my own doctors, I’ve had a few egoists. I always tell them at the beginning that I’m my own medical consultant first, and I will be questioning everything. One doctor assigned to me was so scatterbrained that he ruffled through paperwork for about 20 minutes everytime he saw me. I hated that. But, on the other hand, I don’t know how doctors treat thousands of people a year and remember anybody.

    Thank you for your column, Chris.

    EK

  2. Ellen:

    Thanks for your comments. Regarding tonsillectomies, these days we recommend removing them much less than in years past. This is mainly because antibiotics usually take care of strep infections, even recurrent problems, and the surgery is not risk-free — every couple of months I have a child in the PICU for complications stemming from a tonsillectomy. These days it appears to me that tonsillectomies are more often done for upper airway obstruction from large tonsils rather than for recurrent strep infection. Here’s a link with more information about that.
    http://www.ehealthmd.com/library/tonsillitis/TON_removal.html

  3. Thanks, Chris. It’s good to have you on-line.

    One of our radio hosts just said he got his cold from his partner. That started me thinking about how many URIs children get in the winter. As a pediatrician, you are exposed pretty much all day, every day — much like a day care provider or a teacher!

    Stay well!

    Ellen Kimball
    Portland, OR

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