Question about your role as a med student or resident

[atethesun]

I was flying to my next interview and the gentleman sitting next to me started chatting with me. I am usually quite friendly and talkative.
He noticed that I was reading a medical text and wondered if I'm a med student.
I said yes. He asked me what specialty I want to go into. I said psych. He was delighted that I chose this field.
So we chatted for a bit about life and he said he has some questions to ask me once we take off. My natural response was, "ya sure, just give me a shout when you want to chat after we take off"
Well, it turned out that he wanted to chat with me about his son who is having some psych issues. Although I was interested in listening, I felt that it was not appropriate for me to talk to him about it. So I just ended up saying something really generic along the line of "I am glad that you are doing so much for your son for all these years. A lot of the parents I've met during my rotations don't even care about the patients after a while. Unfortunately, at this point of my training, I am really not equipped to give you any solid advice".


My question is. How do you folks approach these issues?
Normally, I would love to chat with people about their personal problems (I am the go-to-guy for a lot of my male and female friends). But when the person I talk to believes that I can provide medical advice (like this gentleman here), I feel that it falls into the grey area. During this conversation, I didn't even ask anything medically specific about his son like symptoms, current treatment, etc. I felt kinda bad though. He was a really sweet gentleman.

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[mkeguy]

i've had this come up a couple times in medical school. never psych related but more like "i have this bump on my hand." i always play dumb and joke that they can ask me in a few years. if you want to be a jerk you can ask for an insurance card.

really, ive read enough horror stories about people giving advice and having it come back to bite you. atul gawande (sp?) talks about one instance in his life where a lady tripped over his foot at a bus stop and tried to sue him for malpractice cause she knew he had a good financial future in medicine.

id be nice but avoid giving any advice at all. playing dumb works for me!

 

[BobA]

That's why I always tell people I sell insurance.

 

[IAmAUser]

.

 

[PETRAN]

That's why I always tell people I sell insurance.

I bet it comes handy when people are scientologists/anti-pharma/psych-haters and happen to know a lethal martial art




p.s. By the way this is similar to psych graduates. I'm so fed-up with this that i tell people that i do neuroscience research (i have a neuropsych focus in the doctorate anyway) and hope they'll not ask me about stroke and parkinson's.

 

[Saluki]

This happened on almost every plane ride I was on during the first half of interview season... Even when I said that I was studying for a test, it didn't seem to cut people off.

After a while, I finally gave up and just started brining non medical things to read... Otherwise it's hard to tell people that you're just an insurance agent

My family asks me for medical advice as well, though less often since I decided on psychiatry. At Christmas, my younger sister was complaining that there was no point in having someone medical in the family because I always end up saying that she should go see her primary care physician...

 

[billypilgrim37]

At Christmas, my younger sister was complaining that there was no point in having someone medical in the family because I always end up saying that she should go see her primary care physician...

Ah, this is a clear sign you are doing something RIGHT.

Fortunately, my family questions are usually urgent phone calls like "Grandpa took two of his 20mg lipitor tablets instead of one!!! Do we need to take him to the ED to get his stomach pumped?!?!" and "Nephew is going to get his vaccines today, just tell me ONE MORE TIME I'm not going to give him autism so I can feel better."

 

[Bartelby]

echoing others
even when you are no longer a student, giving an individual specific medical/psychiatric advice establishes a doctor-patient relationship and makes you responsible for them. this is not something you want with a stranger on a plane. "talk to your pmd," "call me for an appointment," or "call this clinic for an appointment" are the kinds of responses I give when this comes up.

Very true. One thing that I think can make it less awkward to not offer advice is to let the person know why you can't advise them. If you just say something like "I'm not your doctor and can't give you advice" it seems like you don't care, if you let them know the problems inherent with making diagnoses, giving advice, etc without knowing the patient's full history (or even examining the patient) and recommend establishing care I think that at least lets the person know why you aren't talking.

 

[surftheiop]

I'm the type who really hates to not help people who are looking for help, so is it bad to give really generic "non-medical" advice in addition to telling them to see their doc?

Like someone tells you about having trouble falling asleep at night and you say the generic "talk to your doctor", but also add something about" I dont know if this is relevant to you, but in general exercising, not using computer in bed, no caffeine after 2pm, etc. can help out with that."


Or what about the cases, particularly with extended family, when its obvious that their primary care doc is doing something wrong (like someone w/ "garden variety" depression is on 12 meds and a couple benzos), is it wrong to tell someone they might want to get a second opinion?

 

[AcronymAllergy]

Very true. One thing that I think can make it less awkward to not offer advice is to let the person know why you can't advise them. If you just say something like "I'm not your doctor and can't give you advice" it seems like you don't care, if you let them know the problems inherent with making diagnoses, giving advice, etc without knowing the patient's full history (or even examining the patient) and recommend establishing care I think that at least lets the person know why you aren't talking.

Seconded. Patients/clients almost universally do better when they expect and/or understand what's happening.

 

[Bartelby]

I'm the type who really hates to not help people who are looking for help, so is it bad to give really generic "non-medical" advice in addition to telling them to see their doc?

Like someone tells you about having trouble falling asleep at night and you say the generic "talk to your doctor", but also add something about" I dont know if this is relevant to you, but in general exercising, not using computer in bed, no caffeine after 2pm, etc. can help out with that."


Or what about the cases, particularly with extended family, when its obvious that their primary care doc is doing something wrong (like someone w/ "garden variety" depression is on 12 meds and a couple benzos), is it wrong to tell someone they might want to get a second opinion?

Personally in both of the above cases I would give advice (to a friend or family member, maybe not so much to a random stranger on an airplane). Talking generally about medical diagnoses and advising people to get appropriate help (the doctor in the second example at least appears to be offering inappropriate treatment) seems within the realm of ethical responsibility to me. I think crossing the line would be giving someone a diagnosis and advising medication changes or making other treatment decisions for the person outside of the doctor-patient relationship.

 

[nitemagi]

I've had this since I was a medical student, and still get now after finishing residency. My most recent vignette was talking to a nice couple sitting next to me on a plance, who just had loads of questions about mental illness and the mind. Then the person sitting behind me leans up into our seats.

"I couldn't help but overhead. I just wanted to tell you that I'm reading a great book that explains EVERYTHING about how the mind works...[silence from all of us]...It's called dianetics."

No response from us aside from some nods. He got the message and sat back down.

I generally err on the side of giving non-committal education on a topic without a firm medical opinion on any question they have, and recommend they see someone. "Well that sounds like it could be depression, and a lot of people try medication. Your daughter should talk to her doctor..."

I figure if nothing else, it's an opportunity to network and aid my private practice, plus increase awareness of mental illness.

 

[atethesun]

I've had this since I was a medical student, and still get now after finishing residency. My most recent vignette was talking to a nice couple sitting next to me on a plance, who just had loads of questions about mental illness and the mind. Then the person sitting behind me leans up into our seats.

"I couldn't help but overhead. I just wanted to tell you that I'm reading a great book that explains EVERYTHING about how the mind works...[silence from all of us]...It's called dianetics."

No response from us aside from some nods. He got the message and sat back down.

I generally err on the side of giving non-committal education on a topic without a firm medical opinion on any question they have, and recommend they see someone. "Well that sounds like it could be depression, and a lot of people try medication. Your daughter should talk to her doctor..."

I figure if nothing else, it's an opportunity to network and aid my private practice, plus increase awareness of mental illness.

Is that legal for us residents and med students to say though? Ie: giving your opinion about the matter and then advising to speak with their own physicians?
In my situation, all I said was, "that sounds like a very severe case of _____ *diagnosis provided by the gentlement*"


Still feel kinda bad about not being able to give proper advice =(

 

[nitemagi]

Is that legal for us residents and med students to say though? Ie: giving your opinion about the matter and then advising to speak with their own physicians?
In my situation, all I said was, "that sounds like a very severe case of _____ *diagnosis provided by the gentlement*"


Still feel kinda bad about not being able to give proper advice =(

You give education on a topic in general, not advice or a diagnosis.

 

[atethesun]

You give education on a topic in general, not advice or a diagnosis.

Good point. Thanks!