Take These Steps When Your Doctor Doesn’t Have an Answer
One of the most frustrating moments for many patients is hearing their doctor say, “I don’t know.”
As a hospital physician, I regularly encounter patients who have questions. They want to understand their diagnoses. They’re upset about a lack of answers; they know something is going on with them, but we haven’t figured out what. They feel unmoored and shaken by news of illnesses like late-stage cancer and want to know, why me?
These are questions all medical professionals seek to answer, especially in the modern day physician-patient relationship, where doctors are acting as scientists who study the nuances and details of the body. But there are still many moments in practicing medicine when we may not be able to come up with a definitive answer. Pop culture pushes the idea that doctors know best (and know everything) when medical dramas portray physicians finding miracle cures and teasing out rare conditions in the nick of time.
As a modern doctor, I don’t always have the answer. I can’t explain to parents why their child is suffering from cancer. I’m limited by science, and I can tell parents everything I know about cancer from my practice and studies in scientific medicine. I can offer the parents mortality statistics, likelihood of genetic predisposition, and updated information on effective treatment, but I can’t change the guilt or fear they feel when they learn their child is incurably ill.
Parents often believe they’re responsible for their child’s illnesses, and adult patients worry that they’re at fault for their own ill health as well. The fact is that modern medicine isn’t equipped to answer the eternal patient question, Why me? Why should I suffer?
Physicians are trained to address how the body works, using the scientific approach bound by what we can perceive with evidence. I may be able to explain why some people get certain diseases when others don’t, but medical science still can’t explain why one person with the same lifestyle and genetic predisposition gets sick while another doesn’t.
It can be difficult for doctors, since we want to find every answer we’re able to for our patients, but sometimes there isn’t a simple answer to: Why did I get diabetes? Why does this run in my family? Why did this happen, even though I did my best to stay healthy?
If you’re a patient, you should feel comfortable asking questions of your physician and anyone on your medical team, and you should also be comfortable advocating for your needs. Here’s a list of questions you might run through with your doctor when you’re faced with a situation in which they don’t have the answers you’re looking for.
1. What do you know? If your physician doesn’t have the answer, whether the answer you’re seeking is a specific diagnosis or an explanation for an illness, you might start by asking what they do know. What have they ruled out, and what tests are they still working on? Can they explain to you what treatments and protocols they’ve been through so far?
2. Should I seek a specialist’s opinion or second opinion? A good physician wants you to seek a specialist opinion who can work with you on specialized treatment plans. Also, if you’ve reached a point where you want more answers than your doctor can provide, it might be time to ask about second opinions.
3. Do you need any more information about my medical or family history? Even if you and your physician have a long relationship, it’s possible you haven’t covered every detail of your medical or family history. There might be incidences that didn’t result in a diagnosis at the time but that may now be relevant information for diagnosis or treatment.
4. Can we talk about my follow-up questions? If you’re getting a lot of new information at once, you might have many new questions, too. It could be a good idea to bring a small notebook and write them down as your physician is going through everything, and then bring up those questions afterward to get answers. It’s possible this will even require a second appointment so there’s time to address everything thoroughly.
5. What’s our next course of action? In the face of a challenging diagnosis or an ailment that’s resistant to treatment, it’s easy to get discouraged and feel like your physician isn’t trying their best to help. It’s possible that they’re working behind the scenes to figure out your medical puzzle but have shielded you from some of the more murky and complicated thought processes. Ask your physician what their plan is: Do they think they’ll run more diagnostic tests? Are they keeping you on the same course of treatment for another few weeks, or changing anything? Would they like you to keep a food or sleep log?
6. Have you talked to other members of my medical team? The body is complex, and If you’re visiting multiple specialists, it might be time for your team to communicate about progress and treatment.
7. Can I tell you my biggest concerns? Your physician might be prioritizing based on what they assume is most important to you, but it’s worth letting them know what matters. What concerns you most about diagnosis or treatment? This will help you and your physician prioritize appropriately, especially if you’re coming in with multiple health concerns or if your diagnosis or treatment is complicated.
8. Can we talk about this part of my treatment plan? As a patient, you should always feel completely comfortable asking questions about the diagnostic process and your treatment, and you should be comfortable with how these plans are going. If there’s any part you might want to change, bring it up with your physician during your next visit. And if you’re wondering why your doctor hasn’t tried more treatment plans or ordered different diagnostic tests, talk to them and find out why.
9. What outcomes can I expect from diagnosis and/or treatment? Your physician’s job is to make you aware of all your options and figure out the best course of action together. Even if you’re still early in the diagnostic or treatment process, you can start asking these questions to get these important conversations going.
10. What are the side effects of my treatment plan? Maybe you’ve gone through this step at the pharmacist when you’re picking up a prescription medication, but you can also talk through any and all potential side effects with your doctor — not just of medications, but other treatments as well. If you’re receiving physical therapy, how will that impact your body and what can you expect to feel 1 hour, 5 hours, or a day after your first session? Your physician can also help you work around side effects that you’d most like to avoid, such as if you already have a hard time sleeping at night and you’d rather not risk treatments that could cause insomnia.
11. Can we revisit this another time? Whether it’s getting unexpected bloodwork taken or a treatment plan you’d like time to research on your own, you can always ask your physician if you can come back to something again at your next visit.
12. Are there any questions I haven’t asked yet that I should? Perhaps you and your doctor have run through your treatment options a million times or talked in detail about the side effects of a new medication, but you haven’t discussed what you can do on your own to mitigate the side effects. It can’t hurt to see if there’s any aspect of your medical care that hasn’t been brought up already, but should be.
Your doctor can’t always offer a satisfying explanation for why you’ve received a particular diagnosis. Sometimes environmental factors, genetics, and other external forces converge in a specific way within our bodies. Sometimes people are simply more vulnerable to certain ailments than others. But even when your doctor can’t answer, “Why me?” know that they’re working toward giving you whatever answers they can provide in an effort to provide the care you need.
Read more from Dr. Kurapati. His latest book, Physician: How Science Transformed the Art of Medicine, is available here and is on sale for $0.99 through 11/10.
