agency · doctors · fiduciary · Information · lawyers · Psychology · subjective

If I Were You…

This is something that most of us hear on a regular basis.  Often times it comes during some time off difficulty.  For example, a person who has some medical issues will see a doctor – or more that one doctor – for diagnosis and for a proposed treatment.  A conversation may often go like this:

“The MRI confirmed what I thought.  You have a torn meniscus.”
“Okay.  What are my options, Doctor?”
“If I were you I’d let me scope it.”

Sometimes it happens in other circumstances.  Perhaps a person is unhappily married and is looking to get a divorce. The person might be speaking to a counselor, an attorney, a bartender.  “What would you do?”

This is an easy path to bitterness and contempt.

People Often Seek Experts to Decide for Them

I had the opportunity to speak to a hand surgeon at one point. This fella was pretty amazing, having been accomplished in more than one field. He was a guy that could really get you mad because he was good at everything that he did.  We were discussing something and he said that he is a surgeon. Like all surgeons he could convince everybody to operate if that’s what we want. “Patients agree to do what we want to do.”

I understood what this doctor was saying.  He was saying that patients are often too easily malleable. In such a case, the surgeon actually inserts his o her personal belief and preferences in place of the patient. The patient may not want the surgeon to cut but, on the basis of the superior knowledge of the surgeon and belief that the surgeon knows best, that the surgeon’s judgment is better than his or hers.

It stands to reason that lawyers can and do have the same effect. As to engineers. Contractors. Architects. Dentists. Lawyers can get doctors to agree to do what they want to do.  Most will agree that the lawyer genuinely has the doctor’s best interests in mind.

lawyer doctor
Doctor’s best interest? Underneath the surface, this is what is suspected

Flip Side – People Often Seek People who Tell Them what they Want to Hear

There is another side of this. People are entitled to a second opinion, and they frequently seek one. However, we find that there are people out there who know what they want, what they think, and are seeking validation. Some of these are people who might have a family history of an illness and think that they, too, must have it.  Or perhaps they have heard of something and, running through what they have heard, run through the symptoms and become convinced they have it.

Anybody who went to medical school is familiar with it.  Intern’s disease is a well-known phenomenon. Somebody might see a commercial for some new medication listing symptoms and identifying a disease (and always abbreviated. Ever notice that?). How many people got nauseous and thought of ebola during a few weeks a couple of years ago? You’ll find people who will hunt for doctors to confirm their suspicions.

What Can be Done?

One thing that I have concluded is that a doctor’s job is not to tell a patient what that patient should do.  The doctor’s job is to put herself in the patient’s shoes in order to empathize with the patient. But what the doctor can view as a no brainer may be antithetical to what the patient wants.

Lawyers face the same challenges. “What would you do if you were me?” Something I don’t think a lawyer should answer except to say, “I’m not you.” I think a doctor, lawyer, etc., should be in the business of explaining what it known and providing possible substantive courses of action.  One can do A or B. Here are the positives and negatives of each.  Here are the ups and downs, risks and benefits, and odds on success or failure. Here’s what A will cost. Here’s how long B will leave you laid up.  Etc. “My job isn’t to decide A or B. My job is to know how to get to A or B.”

Patient/Client Should be Educaed but Leave Value Judgment to Patient/Client

Of importance are two subjects: “information assymetry” and “subjective preference.” Information assymetry is a nice descriptive term meaning that in terms of a transaction, one side of the transaction has more information than the other side.  One of the classic examples of this is insider trading.  This is where some person has information unknown to others in a stock market that affects his or her decision to buy or sell. For example, a person may get notification that a bank is going to be bailed out and buys lots of stock before anybody else knows it.

When information is assymetrical, there is an inherent advantage. No doubt that a surgeon, lawyer, accountant, contractor knows far more about the subject of expertise than does the patient/client/customer.  I don’t know how to build a spare bedroom.  But I know what I want it to do. The contractor/architect may think it is folly for me to put a tile roof on a new second floor. “It will require complete structural reframing, it is inordinately expensive because of it, and will require a zoning variance.” They have just done their job in attempting to correct information assymetry.

doc patient
Okay, Doctor. Whatever you say!

This is where the subjective preference of the person comes in.  The person may decide, “It will be too costly and time consuming.  Let’s just go with asphalt shingles.” On the other hand, the client may decide, “No. I want it done. And paint the mancave chartreuse.”  The contractor can make it so.  But the contractor may also think that taupe would be a better color for the mancave.  Doesn’t matter.  There is also information assymetry going the other way.  The client has a reason for wanting chartreuse. It may be something the architect, contractor and Aunt Jenny disagree with, but the customer wants chartreuse. Give it to him.

Understand that the Client/Patient/Customer is Boss

One thing to bear in mind, though, is that the patient/client/vendor is the boss.  Sure, you are a surgeon. Your business is to do operations and this patient is presenting with a symptoms reflective of a tear of the medial meniscus. You’ve got an MRI saying it’s a torn meniscus. Are you going to opt for conservative treatment or for an operation?

Assuming your office manager tells you it can be done after the patient comes up with $5k, you may convince the patient to consent to operation.  If it comes out well, then it’s gonna be a good result for all involved.  On the other hand, if you convince a patient to go through with an operation and it doesn’t turn out well, then that patient is going to be mad.

Work towards empowering the patient. Educate the patient, inform the patient, and leave the decision to the patient alone. Put another way, if you have to retain a lawyer, and that lawyer convinces you to take some action even though you’ve got a lot of questions and worries, then you’ll find yourself in a position of a patient.

The patient is the boss.  The client is the boss.  So long as the person knows what is involved and fully aware of the risks, costs, benefits, etc., that person’s decision governs.

But what would the surgeon do? If the patient doesn’t want the meniscus repaired, then refer off for conservative treatment.  And even perhaps with the suggestion, “If there’s anything else I can do, let me know.”

You are you. Nobody else it. And you are nobody else.

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