AF ablation Doctoring


The patient asked me–in a very serious tone–a series of unusually frank questions.

You look young, how many ablations have you done? How many years of experience do you have? “I have read the success rate is 90% at ___ institute… What is your success rate?”

Honestly, it caught me by surprise.  For a brief moment, I almost contemplated a subliminal message. “Why is she asking me this, and why in this way?” But then, as is always the case, just providing the answer objectively and scientifically saved me.

It got me thinking about the act of asking and answering questions.

When is a question, just a question?  And, what is the threshold for seeing a hidden message in a question?  We tell our patients to be educated, and to ask their doctor questions; we want our students to be engaged and ask their teachers questions. This is surely a good thing, but yet for some doctors the threshold of feeling threatened by in-depth patient inquiry is low, and perhaps getting lower.

As a patient, I was once summarily dismissed by a doctor—no I did not tell him I was a doctor, and he did not ask. (This was in the era before strict coding regulations required an inane number of bullet points on the H and P.)  I had read exhaustively on my shoulder problem. The approach to the problem was controversial and the surgical repairs varied widely. I asked about the specifics of his approach.  He was taken aback, and I was quickly told to not question the specificity of the surgical techniques. “We fix it, our way,” he said in a highly defensive tone. He misinterpreted my question. There was no statement being made, rather I was interested in what he said about the X, or Y repair that I had read about.  Needless to say, this is not the surgeon I chose.

It seems to me that if doctors focus primarily focus on the words of the patient, we will hear just a question.  All can agree, making assumptions is problematic.  Over-analysis leads to paralysis.  You get the picture.  It is just a question.

When I was an EP fellow, the professor would often stand over me and sternly ask, “what are you doing?” Or, “do you know what you are doing?” Although, he was asking a very literal question, initially, in our inexperienced state, it was natural to take a defensive posture. “Geez, does he think I some kind of idiot?” Soon, though, we learned how to answer his questions. “Yes, I know what I am doing.” Well I sort of did, in a fellow-kind-of-way. “I am learning to do electrophysiology, thanks for your help.”

A non-medical example of a person who has perfected the act of answering blunt questions in an opportunistic way is my life insurance guy. Few people believe in themselves and their product more than he.  It’s an old act now, but I used to ask him questions that could easily have been taken personally. I might say, “many have told me that whole life insurance is a scam in which you are incentivized to sell me more so you can make more.” He grins, pauses, and rather than taking the question personally, runs with the opportunity to lay out the benefits of his product.  He answers without a hint of conflict.

Shouldn’t doctors do the same when asked probing questions by patients?

Sure we should. It is easy.  Here are a few examples.

How many have you done?  Easy answer.

How many years experience?  Even easier.

What are the benefits?  Easy, again.  It is a list.  Lists are good.  I can really show my knowledge.

What would you do?  Yes, this is an ideal metric to use.

Are you better than the ‘Institute,’ the one with the the foundation?  That one’s a trick question.  The good news is “I don’t know” is an acceptable answer.  So is, “we are a lot closer to home.” 

As long as the doctor is well trained, free of conflicts, ethical, and acting in the best interest of the patient, challenging questions from patients can be considered just that, questions, not an insinuation or a statement.  Moreover, the inquiry is an opportunity to reveal what we have to offer, an opportunity to be sincere, an opportunity to show humanness. Then the patient can decide.

Yes, I can easily say that I am not the most experienced ablator on the planet. Yes, I have had complications. No, the success rate is not that good. Of course, I am payed well for my work. These are answers that come easily when one just answers the question.

Without doubt, patients help themselves by doing homework and then asking educated questions of their doctor.

Doctors can help themselves by just answering the question.  It is just a question. An answer is the best choice, not another question.

Go ahead, ask me if I am too young to ablate AF.  I will not take offense, but I might refer you for an eye exam.


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