It Pays to Play Dumb Sometimes

People don’t like to be outsmarted by someone else. They don’t like to have their actions questioned. And they really don’t like to have their mistakes or transgressions pointed out to them.

But that’s what we as doctors have a tendency to do. We need to curb those natural impulses if we want to influence people. Unless we are invited by a patient to render our opinion, we are better off not overemphasizing our insightfulness or expertise. If invited, a radical opening statement may be a very effective attention grabber, but not when our opinion may come as an unwelcome surprise to our patient.

Whether it is contradicting a patient’s misperception of the laws of nature or exposing their misuse of prescriptions, food or other substances, we need to tread very carefully if we expect to maintain a therapeutic relationship with our patient.

I often “think out loud” by asking a question, like “I wonder if you’re doing something different now that your weight is going up”. That is a lot less confrontational than “you must be doing something wrong”. Equally effective is to simply ask for the patient’s analysis and then gently probing it for loopholes. This creates a give and take atmosphere where our restraint in the opinion department may even nudge the patient into realizing for themselves what we might have been tempted to tell them in the first place.

The balance we constantly strive for is to be a trusted and credible guide for our patients in their own journey, without trying to replace them as heroes in their story. We cannot assume what all their priorities are when it comes to choosing how to handle medical circumstances and their treatment options. We may think we know what is best for them, but—if we can’t let go of that notion—should at least say that we don’t have all the answers. Otherwise, their success or failure will be entirely on our shoulders. And that can be a perilous spot to be in.

I seldom choose confrontation in my practice, or outside for that matter.

If a patient who is receiving a controlled substance fails a urine drug test, I don’t say, “I know you’re abusing meth/heroin/cocaine”. I just say “There is X in your urine sample and that means I can no longer prescribe controlled substances for you”.

When the patient says they don’t understand how the test could show that, I explain that they definitely had the substance in their urine but that it isn’t my job to figure out how. I suggest it could even have gotten into their system without their knowledge if they accepted a puff of marijuana or a headache pill from someone else. But that doesn’t even matter: I just follow the rules while still allowing my patient a graceful way to accept my decision without having to confess anything.

That way, in this doctor shortage area, I make it possible for my patient to continue getting general medical care from me if they choose to.