when doctors disagree

There should always be ONE right answer to any problem in medicine. You should be able to seek advice from a qualified physician about your symptoms and get an answer. If you present the next doctor you see with the same symptoms he or she should offer you the same advice as the first.

What? That hasn't been your experience?

I suspect it hasn't been the experience of most of you. That is why trust is so important. You need a physician you can trust to "do the right thing" when the ONE right answer isn't necessarily clear. You need a physician willing to say "I don't know" if that is the case, and help you find the right answer for you and your child, for you and your family. None of us can know everything. But we can strive to be certain that we know what we don't know, so we don't get caught up in making assumptions, and jumping to conclusions. Or, worse yet, telling you that the symptoms you report in  yourself or your child are not real, because they don't meet our expectations.

I have been impressed (not favorably) that many physicians, faced with a child or adult with a perplexing illness, or set of symptoms, will tell the parents, after a sequence of negative or unrevealing tests: "there is nothing wrong", or "there is nothing I can do for you." While the latter may be true, is that where the physician's responsibility ends? I am much more favorably inclined toward my colleagues who say: " I don't know the answer, so I am going to consult with colleagues around the country", or "I am going to refer you to someone who is a super specialist in this area", or who will help you to get an appointment with someone you may have found on the internet, or through parent support groups.

But what if there still is not ONE absolutely clear and convincing answer?

What if things are still muddy enough that there is room for debate? Lets say a child is diagnosed with a rare disorder, that may have many different manifestations. What if the symptoms the child is having are not to be found in any textbook or journal article describing that specific disorder?

That is where judgment comes in.

Physicians should be looking at everything they know, everything they can discover about the disorder, and looking at the specific needs of the child, and then work in concert with the family to determine the best path. Will that be the ONE RIGHT PATH?


But the path needs to make sense in the current time, with knowledge that is available. That path may change with time, as more is learned, or the symptoms evolve and change.

So, what if I have two (or more) sets of experts who disagree with each other on how to proceed? For me, the answer is relatively simple: I defer to the choice an informed family has made as to the preferred path. Remember, the family knows their child better than any of us ever can. They know the subtleties of that child's behavior, and how it changes with perturbations of the illness. They may be able to detect signs of illness before there are any OBJECTIVE findings.

We should listen. We must listen.

Do I always know what is right?


But I always strive to know what I don't know, and to listen to all sides of such an issue. My role might be to sit with the parent and ask them questions about what they understand about different options, to help clarify their opinion. What if I disagree with a plan in place? I have to do what I feel is in the best interest of the child; but defining BEST INTEREST is often problematic. It needs to take into consideration more than strict medical issues. It needs to include family values (not physician values), quality of life, social considerations, and more. This is one example of the ART of medicine.

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If you are a patient or a parent, I would love to hear about any experiences you have had where things were not clear, and how you were treated. If you are a health care provider, I would love to hear your thoughts on this matter. If you are a medical educator, or learner, let me know how you think this aspect of medicine is best taught.  If you have read this post, and you have an opinion, PLEASE share it.

We can only learn by sharing our thoughts, and by listening to how physician behavior affects our patients, their families and their colleagues. Please help our community learn by leaving a comment.

About Dr. Ackerman

Alice Ackerman, MD, MBA, FAAP, FCCM is the Chair of the Department of Pediatrics at Carilion Clinic and Professor and Founding Chair of Pediatrics at the Virginia Tech Carilion School of Medicine. Dr. Ackerman is recognized nationally as an expert in pediatric critical care.

She has been at Carilion Clinic since June of 2007. Her primary goals are to enhance the health care of children in the Roanoke Valley and Southwest Virginia, and is actively working to do this both as physician in chief of the children's hospital, as well as through involvement with many state-wide initiatives.

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