A Hamburger, and a Lesson About Medicine

by Lorien E. Menhennett

Last Friday I learned an important lesson about being a doctor – at Five Guys Burgers and Fries.

I was waiting at the counter for my order. Standing next to me was a woman, probably in her 60s, with a walker, also waiting for her food. There must be something about me that looks friendly, because this woman started a rather personal conversation with me. I’d had a rough day, wasn’t really in the mood for chatting, but I could tell she needed someone to talk to. So I listened. The woman told me she’d had heel fusion surgery around Thanksgiving, and was very unhappy with the result. As I listened, I realized it wasn’t the actual result of the surgery that frustrated her, but it was the disconnect between the surgeon’s optimistic attitude and her realistic outcome.

I know there are two sides to every story, and obviously I haven’t heard the surgeon’s side. So it’s quite possible that back in November, when she and her surgeon were discussing the surgery, she heard what she wanted to hear. Her take-home message from those conversations, though, was that by June she would be wearing summer sandals and walking normally. “Instead,” she told me, “I will be wearing a brace that goes halfway up my leg.”

I don’t know for sure, but I think the woman would have been less angry if she felt she had gotten a more realistic prognosis from her doctor. True, it is important for physicians to give their patients hope. But it has to be an honest hope. As a doctor, I think you have to present the various scenarios that could  happen. Not to frighten your patients, but to prepare them.

It’s a fine line to walk, clearly. Optimism and hope can motivate a patient to work harder, to believe he or she can get better. But if you only present the best case scenario, you run the risk of angering your patients, of losing their trust. This woman didn’t say so directly, but I could imagine her considering a lawsuit against her surgeon. Not because he botched the surgery, but because she felt lied to, misled.

As I said, I don’t know the whole story here, so I am certainly not passing any judgment on this surgeon. It could very well be that this woman completely misunderstood what he told her. And as a doctor, you can’t control what patients decide to believe, or what they choose to hear. Even so, I think it does fall on the physician to do all he or she can to present the situation honestly to the patient. With optimism, yes. But also with realism. Because once that trust between a physician and patient is broken, I think it is very difficult, if not impossible, to repair.