Have you ever apologized for not following someone's advice?

[Guest]

Sometimes I feel like a Cassandra, whose advise is never followed. That's not really true, thank God, but as a physician, one can sometimes feel that way. A couple of years ago, I had a patient who had a stool test that indicated a risk of a cancerous or pre-cancerous lesion in her colon. I advised her of the significance of the results, and recommended colonoscopy. She originally agreed, and was scheduled but didn't show up for the appointment. I followed up with her, as did a variety of my staff including nurses and even social workers to see if there were any needs we could help her with, including help with transportation or the preparation for the procedure (she was not going to be charged a penny). She eventually told my staff point-blank that she didn't want the procedure, and they should stop bugging her.

Then last week I was informed she had been admitted to a local hospital due to complications of advanced (Stage IV) rectal cancer. Once she got home, I called her to offer my support and to see if there was anything I could help her with (there was, and I told her I would have my staff work on it). She made no mention of all the efforts we had made for her previously. As I wind down my career and near retirement, I was left reflecting on how rare it is for patients (or anyone else) to apologize after it's clear they should have listened to my advice. I can only think of that happening twice in my 30+ years working as a doctor, both with recovering drug addicts who'd dropped me when I cut off their drugs due to mis-use, then came back once sober. As one of those two said "I realize now, doctor, that you were the only one who cared, and I apologize for how I behaved."

I find it somewhat strange that I can only recall this type of apology from drug addicts. Maybe it's because it's part of the 12-step process that the person make amends for their prior behavior? And I guess maybe it's just part of a stubborn personality that one never apologizes even when one is clearly shown to be in error. Can any of you recall apologizing for not following someone's advice? Or can you remember someone apologizing to you after they didn't follow your advice and suffered the consequences?

[+ Lucky]

I think I am like most people. I apologize when I have not followed serious advice and it turned out to be better than my thinking.

I have told doctors when I realized that they were right, but they rarely apologize to me when they are wrong.

[Islesguy]

When I was a tax accountant, I rarely got an apology from clients who failed to follow my advice even when I have the same advice year and year because a client continued to complain about their tax situation. No matter how many years their situation stayed the same because they didn't follow my advice, all I got was complaining that I wasn't doing better for them. I would even have them fill out forms with me to use and they still wouldn't. Maddening.

[+ bigjoey]

Yes, in business it happened regularly. When the shit hit the fan, there always seemed to be a great excuse for what went wrong. I do not recall ever getting an apology.

[+ WilliamM]

I think I am like most people. I apologize when I have not followed serious advice and it turned out to be better than my thinking.

I have told doctors when I realized that they were right, but they rarely apologize to me when they are wrong.

 

In the 1980s my doctor concluded I had an ulcer without doing a test. He was wrong and never acknowledged his mistake.

 

I became sick from ulcer medicine.

[David1024]

If not an apology, there should at least have been an acknowledgement that your professional advise was well directed.

 

For 13 years I did not visit a dentist out of fear and a bad experience I had at one point. Finally while living in NYC I needed to seek dental help and got a recommendation for an amazing dentist. I decided to honestly explain my fears to him and the reason why my teeth were in such bad shape. Instead of judging me for my neglect, he was kind, compassionate and promised me he would prove that dentistry could be painless. When I left NYC and found a new dentist in CA, I wrote him a letter to thank him for curing my fear and keeping his promise to me. Medical professionals rarely get any acknowledgement when they provide more than the basic service, which is what @Unicorn did.

[Guest]

In the 1980s my doctor concluded I had an ulcer without doing a test. He was wrong and never acknowledged his mistake.

 

I became sick from ulcer medicine.

I started my training in the mid-80s, so I may not be aware of how things worked in the early 80s. By the time I was trained, flexible endoscopy was widely available, so diagnosing a suspected ulcer (and ruling out cancer) was not difficult. Even without flexible endoscopy, an upper GI contrast study can at least show if there's something which needs more workup (it can't differentiate between an ulcer and a cancer, but can at least tell the physician if neither is present). What ulcer medication could make you sick? By the time I started training, cimetidine was available. It was the usual first-line treatment for ulcers, until ranitidine became availalbe, and it very rarely causes side-effects.

My step-father was mis-diagnosed with a stomach ulcer in the early 70s, when there were only radiological studies and rigid endoscopy available. Nevertheless, he had neither for years, and ended up dying with stomach cancer. As a cigarette smoker and drinker with a family history of stomach cancer, he was at obvious risk but never got tested until it was too late. I don't know whether or not his physician ever apologized to him or to my mother.

[Guest]

I think I am like most people. I apologize when I have not followed serious advice and it turned out to be better than my thinking.

I have told doctors when I realized that they were right, but they rarely apologize to me when they are wrong.

I'm curious to hear an example of when your doctor made a mistake. Did the physician not follow accepted professional guidelines or recommendations? For example, sometimes I've had women ask me about being screened for ovarian cancer. I inform them that with current technology, attempts to screen for ovarian cancer are ineffective, and the harms exceed potential benefits.

https://www.acpjournals.org/doi/full/10.7326/0003-4819-157-11-201212040-00539

If the patient later develops ovarian cancer, I was not "wrong" with my recommendation. Physicians have a responsibility to be up-to-date with current knowledge and guidelines. They cannot be held to account for what's not known. That being said, I do often observe physicians not following established practice guidelines, especially in the ER.

[+ WilliamM]

I started my training in the mid-80s, so I may not be aware of how things worked in the early 80s. By the time I was trained, flexible endoscopy was widely available, so diagnosing a suspected ulcer (and ruling out cancer) was not difficult. Even without flexible endoscopy, an upper GI contrast study can at least show if there's something which needs more workup (it can't differentiate between an ulcer and a cancer, but can at least tell the physician if neither is present). What ulcer medication could make you sick? By the time I started training, cimetidine was available. It was the usual first-line treatment for ulcers, until ranitidine became availalbe, and it very rarely causes side-effects.

My step-father was mis-diagnosed with a stomach ulcer in the early 70s, when there were only radiological studies and rigid endoscopy available. Nevertheless, he had neither for years, and ended up dying with stomach cancer. As a cigarette smoker and drinker with a family history of stomach cancer, he was at obvious risk but never got tested until it was too late. I don't know whether or not his physician ever apologized to him or to my mother.

 

Sorry, may I repeat, I didn't have any tests.

 

I am not going to argue with you about getting sick from the ulcer medication. I was there and I was very sick. To be fair, I was better the next day and able to go to work.

 

Very sorry to read about your step father.

[+ Lucky]

I'm curious to hear an example of when your doctor made a mistake. Did the physician not follow accepted professional guidelines or recommendations? For example, sometimes I've had women ask me about being screened for ovarian cancer. I inform them that with current technology, attempts to screen for ovarian cancer are ineffective, and the harms exceed potential benefits.

https://www.acpjournals.org/doi/full/10.7326/0003-4819-157-11-201212040-00539

If the patient later develops ovarian cancer, I was not "wrong" with my recommendation. Physicians have a responsibility to be up-to-date with current knowledge and guidelines. They cannot be held to account for what's not known. That being said, I do often observe physicians not following established practice guidelines, especially in the ER.

Doc got quite excited one day. He had a pulmonary background and told me that I had COPD. Gave me sprays and set me up for a lung scan. Three days later my lung problem had cleared completely. No COPD. His response "well, that cleared up fast!)

My husband was diagnosed in the ER with some awful, incurable condition. Something in the blood, I think. The only thing he could do was take pills that would help "shit out" the offending cells. After a couple of weeks on the toilet he saw another doctor, a liver specialist, who said their was no way he had that condition and took him off the meds. (There were other conditions that preceded this one, and he didn't have those, so couldn't have the bad diagnosis) Original doc didn't say a word when he was notified.

[+ WilliamM]

One seemingly excellent doctor sent me to specialist for possible Parkinson's. The specialist had to cancel because of a family emergency.

 

Luckily, he said, you absolutely don't have Parkinson's.

[Guest]

One seemingly excellent doctor sent me to specialist for possible Parkinson's. The specialist had to cancel because of a family emergency.

 

Luckily, he said, you absolutely don't have Parkinson's.

There are a number of ways to differentiate a Parkinsonian tremor from an essential (more benign) tremor. The easiest and quickest is to have the patient draw an Archimedes spiral, because the result looks very different, comparing a Parkinson's patient to one with essential tremor:

[Guest]

Doc got quite excited one day. He had a pulmonary background and told me that I had COPD. Gave me sprays and set me up for a lung scan. Three days later my lung problem had cleared completely. No COPD. His response "well, that cleared up fast!)

My husband was diagnosed in the ER with some awful, incurable condition. Something in the blood, I think. The only thing he could do was take pills that would help "shit out" the offending cells. After a couple of weeks on the toilet he saw another doctor, a liver specialist, who said their was no way he had that condition and took him off the meds. (There were other conditions that preceded this one, and he didn't have those, so couldn't have the bad diagnosis) Original doc didn't say a word when he was notified.

That was a pretty weird misdiagnosis. First of all, COPD, by definition, is a chronic condition, so if it hadn't been going on for a long time, that was a strange diagnosis to come up with, without even doing any tests. Secondly, COPD is diagnosed with spirometry, not with a "lung scan" (though the latter can look for other things). I hope you steered clear of the 1st doctor from then on. As for the ER doctor, I would always be very wary of diagnoses made by ER doctors (often not the most talented in the medical field). When you mentioned a liver disease in which you have to have one without the other, I'm wondering if he thought your husband had Hepatitis D? One cannot get Hepatitis D unless one also has chronic Hepatitis B, so that's a really bizarre mid-diagnosis... I guess being a dufus also means never having to say you're sorry!

 

Addendum: those two doctors sound like they probably make so many mistakes, that they'd be spending all of their time apologizing!

Edited July 20, 2020 by Unicorn

[RM]

I had an operation about 20 years ago. My doctor cut an artery instead of a vein. I woke up in an MRI machine missing five units of blood. I missed over four months of work, and now have a large scar on my abdomen. During that time I traveled to a meeting and struggled just to walk from my hotel room to the front desk. While I was there, I received an emergency (that’s what they called it) call from the doctor’s office. The emergency was that I hadn’t paid the bill. I guess one can’t apologize for fear of a suit. I haven’t seen him since.

[+ FreshFluff]

In the 1980s my doctor concluded I had an ulcer without doing a test. He was wrong and never acknowledged his mistake.

 

I became sick from ulcer medicine.

 

Sorry to hear that.

 

I’ve had great care overall from physicians, partly due to luck but also because I seek out good care. Unfortunately, a good derm misdiagnosed a BCC in a prominent spot—which turned out to be infiltrative. Even the Mohs surgeons hesitate to pull out the dermatascope, which has been shown to improve diagnosis of BCCs over visual inspection alone. Diagnosis in this area needs some work IMO.

 

(FWIW I've been careful about sun protection since my teens and haven’t sunbathed since I was a small child. Unfortunately, heredity has a big hand in this area.)

[Rod Hagen]

For many people an acknowledgment that they were wrong is nearly impossible. An apology is an admission of being at fault on top of being contrite, for those people it's just too much and all you can do is be grateful that your parents raised you to be capable of expressing humility and gratitude while you assess wether or not you did all that you could, with compassion, and use that knowledge the next time.

 

Also, in instances of catastrophe that results from not taking medical or tax and financial advice, you are dealing with a lot of potential shame. When we feel shame, we often clam up. In fact, it's easy to feel a "fuck you" attitude toward the person who gave you the good advice you didn't take. It's not rational of course, but it happens.

Edited July 20, 2020 by Rod Hagen

[+ poolboy48220]

I don't have an issue with admitting I was wrong, but can't think of a time when I've apologized for it. I'm thinking mostly about work situations though.

 

On a similar note, I've been annoyed when people ignore/disregard help I've given them, and then totally screw up what they're doing. I helped a co-worker write some code, I wrote a 'skeleton' for her program saying in comments "You need to do this here", "once you've verified this, you need to do this here". First thing she did when she started doing the work was to delete all my comments. (headbang)

[Guest]

...Unfortunately, a good derm misdiagnosed a BCC in a prominent spot—which turned out to be infiltrative. Even the Mohs surgeons hesitate to pull out the dermatascope, which has been shown to improve diagnosis of BCCs over visual inspection alone. Diagnosis in this area needs some work IMO....

For me, there's a difference between simply mis-diagnosing, and actively repudiating someone's concerns. A basal cell carcinoma can present as an ulcer (sometimes they're called "rodent ulcers"). If he had told you "This looks like an ulcer. Let's treat you for this for a few weeks, and if it doesn't get better, I'll biopsy it," then I have no problem with his approach. If you had told him "Look, I'm really worried this could be cancer because I have a strong family history," and he said "No way! This is nothing but a regular ulcer. Just put some Neosporin ointment and a band-aid over it, and don't come back regardless of what happens!" then I would have a major problem with his approach.

Essentially, what really pisses me off is when a person rejects good and well-intentioned advice then refuses to acknowledge his mistake when proven wrong. By the way, as an update to my original story, when I called that patient last week, she expressed concern that she wasn't going to be able to make it to her appointment for radiation therapy because of transportation problems. So I had my care coordinator work with a social worker to find an ambulance company who would work with her insurance company. I then completed the paperwork to request the insurance company pay for said ambulance transportation (which was approved). After the social worker called her to notify the patient that the payment for the transportation was approved, she literally just told the social worker that I could stop "wasting my time" because she decided to forgo the radiation therapy. Again, no mention of "I appreciate your efforts" or anything. Pretty amazing.