Remember what it was like to go to the doctor as a child? Yes, there were needle pricks followed by colorful Band-Aids and terrifying, wooden chokey things to facilitate peeking down sore throats.
But there was also the sense that you were in good hands—that even amid the pain and the fear, there was a benevolent, knowledgeable power who was overseeing everything and would offer you some solution for your suffering. (And, thankfully, there was a solution for the vast majority of our childhood ailments.)
Flash forward 20 years. Some of your friends went on to become doctors—friends you trust but who you’re also aware are 100 percent human with the capacity for error.
You’ve had a couple of weird run-ins with your own health that weren’t handled the best way by the doctors you saw, and you’ve been given suggestions that you decided not to follow and diagnoses that you were skeptical of. Later you found out one of the diagnoses was false, rendering all the correlated medical advice complete hooey.
Welcome to adulthood: You still listen to doctors, mostly, but you’re officially a skeptic. You know that doctors don’t know everything and that they never will. You’re aware that there isn’t always a solution.
Even with the healthy dose of disillusionment concerning medical professionals that comes with age, there are still some things you may not know.
Read on for four things your doctor probably won’t say to you, even if they’re true.
1. “You can’t trust my good ratings.”
It’s easy for some doctors to inspire trust in their patients. Maybe they’re charismatic, have a very warm bedside manner, or they’ve never steered you wrong in a diagnosis or treatment plan.
Whatever the case, this is typically a good thing, since confidence in a doctor’s authority may heavily influence how well a patient adheres to the doctor’s prescriptions for health. That’s why a doctor probably won’t go out of their way to let you know that their good ratings don’t always mean all that much.
As Richard Gunderman, MD, PhD, writes in The Atlantic, a doctor’s online ratings can be a slippery gauge of quality for a number of reasons.
These include the fact that you can’t verify whether a reviewer has actually been a patient of the doctor and the lack of reliability in patient satisfaction, which often has less to do with a doctor’s skill and more to do with a doctor’s personality or a patient’s long-term health outcomes.
“Good outcomes do not necessarily reflect good medical care, and the same can be said conversely for bad outcomes,” Gunderman points out.
“A patient with a minor and self-limited viral infection might be very satisfied that a physician ordered several diagnostic tests and prescribed antibiotics, despite the fact that such measures did nothing to hasten recovery. Conversely, a patient with an incurable disease might express great dissatisfaction, despite receiving the very best care possible under the circumstances.”
2. “I’m sick of my job.”
No one wants to appear jaded about their job lest they be seen as ineffective or ungrateful. The stakes can be even higher for doctors, though, given that the price of telling the truth might be a patient’s faith in their abilities.
“How Being a Doctor Became the Most Miserable Profession,” a 2014 article in The Daily Beast, points out that physicians’ unhappiness has been on the rise. As of a few years ago, they were ranked as having the second most suicidal occupation.
A 2016 survey by Merritt Hawkins reports that more than half of American physicians feel “somewhat or very negative” regarding their professional morale and feelings about the current state of the medical profession.
More than a quarter said they wouldn’t be physicians again if they could choose to do their careers over.
“The meme is that doctors are getting away with something and need constant training, watching and regulating. With this in mind, it’s almost a reflex for policy makers to pile on the regulations,” writes Daniela Drake, MD, for The Daily Beast.
“Regulating the physician is an easy sell because it is a fantasy—a Freudian fever dream—the wish to diminish, punish and control a disappointing parent, give him a report card, and tell him to wash his hands,” Drake adds.
3. “Your insurance company makes me jump through hoops.”
Though your doctor will spare you the gory details, your insurance company probably makes their life much more difficult.
Whether your doctor has to dispute a lower level of care recommended by your insurance company or mail them your surgically removed toenail for documentation purposes, you can safely assume that they are not your insurance company’s No. 1 fan.
Illinois family physician and geriatrician Jerome Epplin tells MarketWatch that this is because the people making decisions aren’t actually seeing the patients.
Epplin says that despite his efforts to request costly tests such as magnetic resonance imaging only when they are absolutely necessary, insurance companies routinely reject the claims—even when Epplin has good reason to believe a patient’s health is in peril.
4. “You’re going to die.”
If you or a loved one is diagnosed with a terminal illness, you will likely expect all the details about the prognosis to come from your doctor. As a New York Times article highlighted last year, this is not necessarily true.
The article’s author, Paula Span, points to a study of 178 cancer patients nationwide led by Dr. Holly Prigerson, director of the Center for Research on End-of-Life Care at Weill Cornell Medicine.
After interviewing patients, Prigerson and her colleagues found that even when doctors had knowledge that their patients’ cancer had progressed despite chemotherapy—and regardless of their expectations that these patients had less than six months to live—a significant number of doctors did not inform their patients.
Almost 40 percent of the participants interviewed reported that their physicians had never discussed prognosis or life expectancy with them.
Only nine out of 178 patients—or 5 percent of those interviewed—had a complete enough understanding of their illnesses to correctly answer each of the four illness-understanding questions used in the study.
Some of this can be attributed to miscommunication (like a doctor’s usage of language that isn’t clear to a patient) and optimism bias (the tendency to hope for the best outcome despite evidence to the contrary—aka denial). Some of it, however, is due to doctors literally not telling their patients that they have only months to live.
Why? Sometimes it’s for pragmatic reasons: As Span writes, some oncologists believe that failing to offer chemotherapy—even when it won’t do any good—will only encourage patients to hunt down a doctor who will.
But it’s also just hard to be the bearer of bad news—and many doctors still aren’t trained in how to properly deliver difficult, but essential, information.