When friends ask you for medical advice..

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Kinis

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Happens to me occasionally, the "you're close to becoming a dr. right?", "erm a few years.. why?" "Well..Now I've got this weird rash right here.."
My stock answer is kind of a "I just learn textbooks by heart, couldn't and wouldn't be allowed to diagnose you, maybe go see someone who has actually graduated?".
Anyone got some good stock phrases/ways for when this happens?
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Kinis said:
Happens to me occasionally, the "you're close to becoming a dr. right?", "erm a few years.. why?" "Well..Now I've got this weird rash right here.."
My stock answer is kind of a "I just learn textbooks by heart, couldn't and wouldn't be allowed to diagnose you, maybe go see someone who has actually graduated?".
Anyone got some good stock phrases/ways for when this happens?
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I usually take a look, listen, whatever, then follow it up with "yeah you should probably go see your doctor about that".

Most people seem happy with that :naughty:
 
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"I think it's syphilis." Works every time.
 
Kinis said:
Happens to me occasionally, the "you're close to becoming a dr. right?", "erm a few years.. why?" "Well..Now I've got this weird rash right here.."
My stock answer is kind of a "I just learn textbooks by heart, couldn't and wouldn't be allowed to diagnose you, maybe go see someone who has actually graduated?".
Anyone got some good stock phrases/ways for when this happens?
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Has happened a handful of times (and I am just a first year!). If it is something serious, I say "no idea go see a real doctor." However, a family member asked about something minor and I told them what I thought based upon my 6 months of knowledge haha.
 
"What are the answer choices? I only work in multiple choice."

I have a medical degree, and even worked abroad. I have to look at my friends like I don't speak English.
 
Kinis said:
Happens to me occasionally, the "you're close to becoming a dr. right?", "erm a few years.. why?" "Well..Now I've got this weird rash right here.."
My stock answer is kind of a "I just learn textbooks by heart, couldn't and wouldn't be allowed to diagnose you, maybe go see someone who has actually graduated?".
Anyone got some good stock phrases/ways for when this happens?
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Just tell them if they want advice you have to first give them a full physical, including DRE.
 
Just rattle off some ddx (doesn't have to be the CORRECT ddx--they'll never know). That way they'll think you're smart.
Finish off with "It's hard for me to narrow it down without all the right equipment and lab tests. you should probably just go to your doctor." That way they'll understand you know your limits.
 
I just dx them. My nephew had some skin issues so my sister picture texted me a photo of it. Molluscum contagisum baby. Honestly just learn a little bit of common derm stuff and you can easily field those rash questions. Those tend to be like 90% of the free medical advice questions family/friends ask me. And if you don't know, don't bs it, just tell them to see there doc.
 
badasshairday said:
I just dx them. My nephew had some skin issues so my sister picture texted me a photo of it. Molluscum contagisum baby. Honestly just learn a little bit of common derm stuff and you can easily field those rash questions. Those tend to be like 90% of the free medical advice questions family/friends ask me. And if you don't know, don't bs it, just tell them to see there doc.
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This is how you end up being sued into oblivion. Say what seemed like a simple derm condition might really be a rare presentation of a cancer and your diagnosis could result in delayed treatment. You don't yet have enough knowledge or experience, you don't have a license, you don't have malpractice insurance. And speaking as a lawyer I can assure you people do get sued by their friends and family members all the time. There's a reason residency takes years -- you simply aren't ready to practice without a net after your one month of derm, or early in residency, etc. So no, don't ever do this.
 
Law2Doc said:
This is how you end up being sued into oblivion. Say what seemed like a simple derm condition might really be a rare presentation of a cancer and your diagnosis could result in delayed treatment. You don't yet have enough knowledge or experience, you don't have a license, you don't have malpractice insurance. And speaking as a lawyer I can assure you people do get sued by their friends and family members all the time. There's a reason residency takes years -- you simply aren't ready to practice without a net after your one month of derm, or early in residency, etc. So no, don't ever do this.
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thanks for the advice

it was my limited understanding that med students couldn't establish doctor-patient relationships, but once you are in residency you should never give advice

either way i'm safe i play the "you should see a doctor" card
 
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Law2Doc said:
This is how you end up being sued into oblivion. Say what seemed like a simple derm condition might really be a rare presentation of a cancer and your diagnosis could result in delayed treatment. You don't yet have enough knowledge or experience, you don't have a license, you don't have malpractice insurance. And speaking as a lawyer I can assure you people do get sued by their friends and family members all the time. There's a reason residency takes years -- you simply aren't ready to practice without a net after your one month of derm, or early in residency, etc. So no, don't ever do this.
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While I understand the rules behind it all. (And I don't offer medical advice for obvious legal reasons.) It makes no sense how someone IN medicine isn't allowed to give advice/their opinion or simply say "This is what it says in so and so textbook". Whereas a person outside of medical training can say whatever they want based off something they read off the internet. Why are medical students suddenly more liable or residents?

Also, in that case, what proof is there that they even said, "Oh, that's just so and so..." Innocent until proven guilty doesn't apply to medical students or residents?

Guess they have to say, "Sorry, I can't answer that question for another 365x3 days (end of residency). When I wake up that morning, I will apparently morph into a diagnosing demi-God. I will be incompetent until then."
 
CDI said:
While I understand the rules behind it all. (And I don't offer medical advice for obvious legal reasons.) It makes no sense how someone IN medicine isn't allowed to give advice/their opinion or simply say "This is what it says in so and so textbook". Whereas a person outside of medical training can say whatever they want based off something they read off the internet. Why are medical students suddenly more liable or residents?
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I think the difference would be in the fact that if a patient were to receive advice from a friend outside the field, that patient knows that that is a layperson's interpretation and despite how useful that advice may be, it is no substitute for a doc's opinion.
But, if a medical student were to give what they think is some innocuous advice, the patient/friend could, falsely, interpret this as being valid enough to not have to seek the opinion of a doctor.
 
CDI said:
While I understand the rules behind it all. (And I don't offer medical advice for obvious legal reasons.) It makes no sense how someone IN medicine isn't allowed to give advice/their opinion or simply say "This is what it says in so and so textbook". Whereas a person outside of medical training can say whatever they want based off something they read off the internet. Why are medical students suddenly more liable or residents?

Also, in that case, what proof is there that they even said, "Oh, that's just so and so..." Innocent until proven guilty doesn't apply to medical students or residents?

Guess they have to say, "Sorry, I can't answer that question for another 365x3 days (end of residency). When I wake up that morning, I will apparently morph into a diagnosing demi-God. I will be incompetent until then."
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1. You are more liable once you have advanced knowledge or degree and/or hold yourself as having such. once you start down the path of medicine, the friendly advice you give has more meaning to others, and if you tell them it's probably nothing, they may not seek actual treatment, to their detriment. The problem is their reliance on you, not your intent. So yes, your liability changes when you start down this path. There are good Samaritan exceptions for emergent situations, but in general giving advice to friends and family will set you up for liability problems if you don't meet the standard of care.

2. While burden of proof is on the person suing, you have to realize that they will be sick/injured, while you will be seen as the future rich doctor. Juries will sympathize with them and dislike you every time. That's the hard truth -- you don't get to make mistakes in this field without consequences. You lose all the "he said -she said" contests. And no, it's not innocent until proven guilty for a civil suit, it's a question if whether a preponderance of the evidence supports the plaintiff. So really a judgment call based on who the jury want to believe. Not a good path for the faint hearted.

Bottom line, its foolish to give medical advice before you are licensed, insured, and complete a residency.
 
Kinis said:
I think the difference would be in the fact that if a patient were to receive advice from a friend outside the field, that patient knows that that is a layperson's interpretation and despite how useful that advice may be, it is no substitute for a doc's opinion.
But, if a medical student were to give what they think is some innocuous advice, the patient/friend could, falsely, interpret this as being valid enough to not have to seek the opinion of a doctor.
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Precisely.
 
I let them ramble on about their problem, and then tell them that if they are concerned enough to ask someone who doesn't know anything, they are concerned enough to go see their doctor.
 
Law2Doc said:
This is how you end up being sued into oblivion. Say what seemed like a simple derm condition might really be a rare presentation of a cancer and your diagnosis could result in delayed treatment. You don't yet have enough knowledge or experience, you don't have a license, you don't have malpractice insurance. And speaking as a lawyer I can assure you people do get sued by their friends and family members all the time. There's a reason residency takes years -- you simply aren't ready to practice without a net after your one month of derm, or early in residency, etc. So no, don't ever do this.
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I understand the concern. BUT, I am not going around telling people, "yeahhh, that mole looks fine, don't even worry about it."

How common is molluscum contagiosum on kids? I tell them "this is what I think it is, but you should f/u with you doctor."

It is like looking at an elephant at the zoo and telling a small child that,"That is an elephant." Or as you guys advocate I should say, "Um it could be a zebra, horse, seal, maybe you should just ask the zoo keeper even though I went to zoo school."

Another example was my cousin asking me what was on her fingernails. She read online it could indicate heart problems. So I'm thinking hmm, maybe she read some crap on webMD about splinter hemmorhages and endocarditis? So I looked at it, and I've known her all my life, she has no other signs or symptoms of endocarditis (and the lesions on her fingernails did not look like splinter hemmorhage) . SO I tell her it probably isn't related to your heart, but you should see your doctor about it because there are other tests that can help r/o if it is related to your heart or not.

Is that so wrong?

I've run codes without any senior person taking it over from me. I start people on heparin when they have PE's. I treat basic derm conditions with steroids. I should not give medical advice if I am 100% confident in what it is?

Lawyers always take away all our fun. :(
 
I usually just give them a bit of a DDx... i.e. "it's probably X, but it could also be something more serious like Y, so you should see a real doctor."

And I also slip in a joke about how they could sue me if I'm wrong, so that ensures that people know why I'm being vague.
 
If it is a woman, I generally ask more about what is going on, and once they look like they have gone on long enough I tell them that "we see that sometimes in pregnancy". Then I laugh inside as they panic, trying to remember if that is even a possibility...

If it a guy, I take the same approach, though I either tell them they have cancer or they have AIDS.
 
ericL said:
If it is a woman, I generally ask more about what is going on, and once they look like they have gone on long enough I tell them that "we see that sometimes in pregnancy". Then I laugh inside as they panic, trying to remember if that is even a possibility...

If it a guy, I take the same approach, though I either tell them they have cancer or they have AIDS.
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Great way to get people to stop asking you for medical advice. Might lose a friend or two over it.
 
If your friends don't have a sense of humor they probably shouldn't be your friend; unless you don't have a sense of humor either and want people like that around then you wouldn't even think of saying something like that.
 
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CDI said:
So... I should stop telling people its lupus.
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454657.jpg
 
Law2Doc said:
This is how you end up being sued into oblivion. Say what seemed like a simple derm condition might really be a rare presentation of a cancer and your diagnosis could result in delayed treatment. You don't yet have enough knowledge or experience, you don't have a license, you don't have malpractice insurance. And speaking as a lawyer I can assure you people do get sued by their friends and family members all the time. There's a reason residency takes years -- you simply aren't ready to practice without a net after your one month of derm, or early in residency, etc. So no, don't ever do this.
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This might be the safest approach, but if you have siblings who would sue you for misdiagnosing their child's molluscum, then you have bigger problems.

Of course, you should never get in over your head. My mom called me on a weekend when I was an M3 because my dad had what sounded to me like a partial complex seizure (LUE twitching, petit mal symptoms), so I told her to call whoever was on call for his PCP. They were then referred straight to the ED, where it turned out he had had a small stroke.

Realistically though, I usually tell people "To get a complete story, I'd have to ask you too many questions that you don't want to answer, and I don't want to hear. You should probably see a specialist about that."
 
TheProwler said:
Realistically though, I usually tell people "To get a complete story, I'd have to ask you too many questions that you don't want to answer, and I don't want to hear. You should probably see a specialist about that."
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This really is the best approach. Even when I am all finished with training and licensed etc. I don't think I'll be open to giving casual medical advice to friends and family.

It's not that I'd worry about being sued, or anything like that. But more that I don't want to be the go to person for medical care and advice when I'm not at work. Like my neighbor growing up who was a really good mechanic; as soon as the neighborhood realized what he did, he was constantly getting pulled into diagnosing everyone's car problems, loaning out tools, and fixing things for people who didn't want to pay for shop time. He was nice about it, but I know he didn't enjoy it.

I'd like to keep my friends and family relationships as normal as possible.

Plus, as the Prowler has implied, there are plenty of things that friends/adult family members should never share with each-other, things that will cause all kinds of weirdness from that point on.

So like I said in my first post, I usually just listen to their superficial description of their problem, let them feel like they told me what was wrong, then tell them I think they should go see a doctor about it.
 
For me, it's usually not people asking for a diagnosis. It's usually something like this: "my doctor told me I have this, and that I should do this. What do you think?"
 
TheProwler said:
This might be the safest approach, but if you have siblings who would sue you for misdiagnosing their child's molluscum, then you have bigger problems. ...."
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again, as a former lawyer, I can assure you siblings sue all the time, as do friends, and it always comes as a surprise to the defendant.
 
Stellar Clouds said:
For me, it's usually not people asking for a diagnosis. It's usually something like this: "my doctor told me I have this, and that I should do this. What do you think?"
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yea that happens a lot too. my dad had bilateral inguinal hernias and wanted to know whether he should go with open or laproscopic.
 
badasshairday said:
yea that happens a lot too. my dad had bilateral inguinal hernias and wanted to know whether he should go with open or laproscopic.
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The problem there isn't so much that you will be sued, but you won't always even know all the reasons that option was given. Whether something can be done laparascopically depends a lot on the imaging and on the underlying abilities of the surgeon. Maybe something seen on the imaging makes something laparascopic more difficult. And You will certainly meet surgeons, usually older guys, who simply push for open because that is here their comfort level is -- you wouldn't want to push a patient to have laparascopic work done with that particular surgeon if he is only comfortable if he can actually get his hand on the organ. So it's again risky unless you are finished with training and prepared to offer yourself up as the alternate surgeon.
 
Law2Doc said:
The problem there isn't so much that you will be sued, but you won't always even know all the reasons that option was given. Whether something can be done laparascopically depends a lot on the imaging and on the underlying abilities of the surgeon. Maybe something seen on the imaging makes something laparascopic more difficult. And You will certainly meet surgeons, usually older guys, who simply push for open because that is here their comfort level is -- you wouldn't want to push a patient to have laparascopic work done with that particular surgeon if he is only comfortable if he can actually get his hand on the organ. So it's again risky unless you are finished with training and prepared to offer yourself up as the alternate surgeon.
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Yeah, when somebody asks me a question like that, I usually say something like "I'm sure the specialist knows better than I do."
 
I usually try to make a joke and change the subject or give the AIDs answer. I usually say it in a way that they know I'm joking though.

If people push I almost always tell them to go to the doctor or the ER.
 
Law2Doc said:
The problem there isn't so much that you will be sued, but you won't always even know all the reasons that option was given. Whether something can be done laparascopically depends a lot on the imaging and on the underlying abilities of the surgeon. Maybe something seen on the imaging makes something laparascopic more difficult. And You will certainly meet surgeons, usually older guys, who simply push for open because that is here their comfort level is -- you wouldn't want to push a patient to have laparascopic work done with that particular surgeon if he is only comfortable if he can actually get his hand on the organ. So it's again risky unless you are finished with training and prepared to offer yourself up as the alternate surgeon.
Click to expand...

The most messed up thing about it was that the surgeon did a laparaoscopic fellowship at UCSF and felt comfortable doing open and laparascopic. She left it up to him!

So I talked to a bunch of surgeons, young attendings, old attendings, residents, fellows, and come to the conclusion that.... (not going to share and give away free medical advice!)
 
badasshairday said:
The most messed up thing about it was that the surgeon did a laparaoscopic fellowship at UCSF and felt comfortable doing open and laparascopic. She left it up to him!

So I talked to a bunch of surgeons, young attendings, old attendings, residents, fellows, and come to the conclusion that.... (not going to share and give away free medical advice!)
Click to expand...

...laparoscopic inguinal hernia repair is technically difficult and probably should only be done by someone with lots of experience?

Although bilateral is typically done laparoscopically (at least at the hospital I did gen surg at).
 
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1st year attitude- let me use my impractical book knowledge to answer this extremely routine clinical problem!

End of 3rd year attitude- relative strangers asking you about their routine problems when they hear you're a medical student no longer seems interesting. Actually it's not that annoying, but the guy in my apartment office who talked about his sinus drainage for 15 minutes last week was though.
 
Oh no's, my mom just asked me about a derm question over the phone. She put on some jewelry and subsequently had a presumed allergic dermatitis (prob shouldn't diagnose it as such because I'm not a licensed MD). I told her to put on topical ........ (can't say the medical advice.)

Now I wonder if L2Doc has seen a mother sue there doctor son. LOL, that would have to be a first.

:)
 
badasshairday said:
Oh no's, my mom just asked me about a derm question over the phone. She put on some jewelry and subsequently had a presumed allergic dermatitis (prob shouldn't diagnose it as such because I'm not a licensed MD). I told her to put on topical ........ (can't say the medical advice.)

Now I wonder if L2Doc has seen a mother sue there doctor son. LOL, that would have to be a first.

:)
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Unfortunately, it wouldn't be a first. Or a fifth. Or even an eleventieth. Family members, even parents/children sue each other pretty frequently. Maybe your mom won't but I bet someone who reads this forum has a mom that would in a heartbeat.
 
Physio Doc 2 Be said:
Unfortunately, it wouldn't be a first. Or a fifth. Or even an eleventieth. Family members, even parents/children sue each other pretty frequently. Maybe your mom won't but I bet someone who reads this forum has a mom that would in a heartbeat.
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Just ask eminem.
 
Law2Doc said:
The problem there isn't so much that you will be sued, but you won't always even know all the reasons that option was given. Whether something can be done laparascopically depends a lot on the imaging and on the underlying abilities of the surgeon. Maybe something seen on the imaging makes something laparascopic more difficult. And You will certainly meet surgeons, usually older guys, who simply push for open because that is here their comfort level is -- you wouldn't want to push a patient to have laparascopic work done with that particular surgeon if he is only comfortable if he can actually get his hand on the organ. So it's again risky unless you are finished with training and prepared to offer yourself up as the alternate surgeon.
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You don't have to. You just have to know generic risks and benefits to tell them what the differences are between the procedures when they ask and why you might choose one over the other. The surgeon is responsible for not suggesting an option that he's not comfortable doing.

Law2Doc said:
again, as a former lawyer, I can assure you siblings sue all the time, as do friends, and it always comes as a surprise to the defendant.
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And as a current sibling and friend, I still think that's a highly dysfunctional relationship. I didn't say it didn't happen. I will still continue to give very casual advice or suggestions of things to mention to the physician (my great-uncle was getting an angiogram, and my brother was going with him to visits, and I made sure my brother told them that the uncle had a solitary kidney), but like I said, I don't/won't give detailed advice, because I don't want to hear about my family members' bowel habits or dysuria.

badasshairday said:
The most messed up thing about it was that the surgeon did a laparaoscopic fellowship at UCSF and felt comfortable doing open and laparascopic. She left it up to him!
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That's not messed up at all.
 
TheProwler said:
That's not messed up at all.
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Didn't mean it's messed up, messed up. Just that it ended up being MY decision as my dad trusts me because I'm a doctor... even though I'm not a surgeon. So I did my homework and read about that large VA study that compared open to laparoscopic, taking into account surgeon experience, and talked to some surgeons. I came to my own educated conclusion and let my dad know so he could make the final decision.

Don't forget, we as physicians, no matter what specialty, have MUCH more insight into illnesses, prognosis, treatment, procedures than lay people.
 
TheProwler said:
That's not messed up at all.
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I wouldn't call it messed up, but I have always felt that most medical professionals I've worked with are far too hesitant to strongly suggest an option when multiple viable options exist.

In this case Instead of just laying out the relative risks/benefits of open versus laparoscopic, the surgeon should lay out the relative risks/benefits of both, and then provide his expert opinion strongly recommending one for this particular patient based on his expertise and knowledge of this particular patients disease and priorities.

The patient is free to disagree and make his own decision, but ultimately we as physicians must provide our opinions based on both the book knowledge and practical experience we have.
 
The two best replies of the ones that I read (I did not read all of them) are:

Trastuz said:
"I think it's syphilis." Works every time.
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Gosh, I love this one. So funny. I always answer with, "I am not a doctor, please don't ask me anything yet". Then I go into a lecture about safe sex, healthy nutrition, exercise and doing regular check ups with a doctor. Otherwise, I go out of my way to tell them NOT to see me as a doctor.

This one was pretty funny as well, though it's definitely an inside joke:

CDI said:
"What are the answer choices? I only work in multiple choice."
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Do we really want to tell people we are training to be doctors via multiple choice questions? I am still stunned this is our testing method, albiet extremely difficult. I thought fill in the blanks and opened ended questions were expecting me in med school

Check out my blog for non-traditional students:

http://roadlesstraveledmd.wordpress.com
 
roadlesstravel said:
The two best replies of the ones that I read (I did not read all of them) are:



Gosh, I love this one. So funny. I always answer with, "I am not a doctor, please don't ask me anything yet". Then I go into a lecture about safe sex, healthy nutrition, exercise and doing regular check ups with a doctor. Otherwise, I go out of my way to tell them NOT to see me as a doctor.

This one was pretty funny as well, though it's definitely an inside joke:



Do we really want to tell people we are training to be doctors via multiple choice questions? I am still stunned this is our testing method, albiet extremely difficult. I thought fill in the blanks and opened ended questions were expecting me in med school

Check out my blog for non-traditional students:

http://roadlesstraveledmd.wordpress.com
Click to expand...

I'm a US-IMG from a fairly rigorous program. We had all written exams. This system seems a lot cozier so far...mmm multiple choice.
 
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If I tell things to people, I do caution them and tell them to speak to a physician.

I'm way more cautious now, especially on Facebook where I need to cover my ass. I've gotten so paranoid that I won't even post things from Doc McStuffins (my girlfriend was a pre-school teacher so go figure).

We live in a very litigious society, so be careful!
 
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