In any relationship a simple misunderstanding has the potential to undermine something good.  Doctors and patients are no different.

I recently consulted with a mother concerned about the distended appearance of her baby’s belly.  Before the visit her mom had done her diligence by taking digital images of her daughter’s abdomen.  Dozens actually.  And at her visit she produced her laptop so that I could check out the images she had dutifully captured.  After the first 15 photographs of her baby’s full midsection I suggested that we didn’t need to go any further.  I understood what she was describing.

Mom was slightly perturbed that I didn’t feel the need to see the entire show.  To her all of the pictures were important.

Patients bring along odd pieces of information to the exam room.  Good doctors collect, consider and process these pieces.  Some patients or parents cling to elements of their story – their ‘pieces’ and their beliefs.  When doctors dismiss those beliefs it has the tendency to create resentment.

The answer to this is to recognize dual responsibility on the part of doctor and patient.  The patient has to recognize that their beliefs may be ill-conceived.  The doctor has to recognize that there may be pieces of a patient’s history that hold unique clues to diagnosis.

A patient should always be given the opportunity to create a ‘clear conscience’ through some discussion of what they think may be important.  What I do personally is to use the time between my history gathering and my physical exam to allow parents to offer their ideas on what may be going on.  It’s during this time that I close my EMR, wash my hands, approach the bedside, and actively listen.  It’s a transition that helps create natural dialogue and allows a parent the time to unload something that they may have been holding in.

There’s a disconnect between what a patient thinks a doctor needs to know and what a doctor needs to know.  Doctors bear the responsibility of bridging that gap.  The best among us do it effortlessly.

The details of this story were altered considerably to protect the privacy of the patient.