Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Accepting reasonable expectations is a gamechanger for patients

Michael Kirsch, MD
Conditions
April 29, 2013
Share
Tweet
Share

One of the toughest parts of treating patients is managing their expectations.  We wish that everyone could enjoy a perfect recovery with complete healing, but the medical profession is imperfect and life is unfair.  Some folks cruise by decade after decade without a scratch, while others sag under the weight of chronic illnesses.

Accepting reasonable expectations can change the game for patients and their families.  If the patient’s expectations exceed what is possible, then the patient will never be satisfied and the dissatisfaction may assume a life of its own, which can torment with virulence equal to the disease.   Second and third opinions may be sought, which usually lead to more testing and frustration.  Learning to accept what is possible – though enormously challenging – creates a path toward leading a fuller and more satisfying life.   While I haven’t been burdened with a chronic disease, I do personally understand that acceptance of a situation opens a path toward healing.

You have just experienced the joy and delight of a colonoscopy.   The physician approaches you afterwards to inform you of the results.  Which of the following  hypothetical responses would you prefer?

We found a lesion in the large intestine that we are very concerned about.  The biopsies will be available in 48 hours. 

The colonoscopy was completely normal.

Of course, I am not entirely serious here.  We all hope and pray for the second response.  Yet, often, when I reassure patients that their colons are pristine, many react with frustration and disappointment.  This usually occurs with patients who are suffering chronic abdominal pain and distress and are desperately seeking a concrete explanation for their symptoms.  They enter the colonoscopy suite with stratospheric expectations that my scope will crack the code of what has stymied other physicians for years.

These expectations are fueled when other doctors they have seen advised that their pain is clearly coming from their stomach and intestines.  So, when the CT scans and ultrasounds and blood tests and emergency room visits are all non-diagnostic, they want to believe that the light of the colonoscope will illuminate the diagnosis.

The light of my scope is really quite limited.  It’s an accurate tool for many conditions, but is a clumsy diagnostician for chronic pain.  Of course, the pain is real.  But, our tools to identify its cause are often crude and inaccurate.  In some instances, of course, there may be an occult diagnosis that the physician has overlooked.  In most cases, however, the pain has no identifiable medical explanation.

At some point, a patient with chronic, unexplained pain must veer away from the quest to find its cause and onto the journey of living as full a life as possible with the condition.  The choice may be ruling over the disease or being ruled by it.

Blogging about this is easy and comfortable, particularly when your humble scrivener is not suffering chronic pain.  But I have seen patients who summon grit and moxie to stay in charge of their symptoms and their lives.  They might not reach the end zone in one play or two, but they are steadily moving the ball downfield.  Their efforts and successes are inspiring.  I hope I have learned something from them.

Life is unfair and unpredictable.  Which path do we choose when we are challenged?

God grant me the serenity 
to accept the things I cannot change; 
courage to change the things I can;
and wisdom to know the difference.

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.

ADVERTISEMENT

Prev

The KevinMD toolkit: Blogging

April 29, 2013 Kevin 6
…
Next

The skills that tomorrow's doctors will need

April 29, 2013 Kevin 1
…

Tagged as: Gastroenterology

Post navigation

< Previous Post
The KevinMD toolkit: Blogging
Next Post >
The skills that tomorrow's doctors will need

ADVERTISEMENT

More by Michael Kirsch, MD

  • Are Ozempic patients on a slow-moving runaway train?

    Michael Kirsch, MD
  • AI-driven diagnostics and beyond

    Michael Kirsch, MD
  • The surprising truth behind virtual visits

    Michael Kirsch, MD

More in Conditions

  • Why telling kids to eat less and move more fails to address obesity

    Callia Georgoulis
  • Clinical ghosts and why they haunt our exam rooms

    Kara Wada, MD
  • High blood pressure’s hidden impact on kidney health in older adults

    Edmond Kubi Appiah, MPH
  • How declining MMR vaccination rates put future generations at risk

    Ambika Sharma, Onyi Oligbo, and Katrina Green, MD
  • How one unforgettable ER patient taught a nurse about resilience

    Kristen Cline, BSN, RN
  • Why regular exercise is the best prescription for lifelong health

    George F. Smith, MD
  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why telling kids to eat less and move more fails to address obesity

      Callia Georgoulis | Conditions
    • Why enterprise risk management is key to value-based health care success

      Olumuyiwa Bamgbade, MD | Physician
    • Rethinking physician resilience for sustainable well-being

      Sarah Webber, MD | Physician
    • How shared language saved a patient from isolation

      Syed Ahmad Moosa, MD | Physician
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Harassment and overreach are driving physicians to quit

      Olumuyiwa Bamgbade, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why telling kids to eat less and move more fails to address obesity

      Callia Georgoulis | Conditions
    • Why enterprise risk management is key to value-based health care success

      Olumuyiwa Bamgbade, MD | Physician
    • Rethinking physician resilience for sustainable well-being

      Sarah Webber, MD | Physician
    • How shared language saved a patient from isolation

      Syed Ahmad Moosa, MD | Physician
    • The shocking risk every smart student faces when applying to medical school

      Curtis G. Graham, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Accepting reasonable expectations is a gamechanger for patients
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...