ABSTRACT
I remember that the day was lovely with blue skies and a fresh breeze, but my mother and I were too anxious to enjoy the weather. I had accompanied her to a neurologist because she had tingling and mild weakness in both hands and arms. The computed tomography and magnetic resonance imaging scans ordered by her internist had been unremarkable, so we hoped that the trip to the neurologist would be informative. The neurologist asked her questions regarding her symptoms and conducted a neurological examination. He reported to us that “she probably had a mild stroke” that did not show up on the scans. My mother asked him to explain what sort of stroke would produce that set of “bilateral symptoms.” Ignoring her use of relatively “informed” terminology, the neurologist proceeded to define stroke and risk factors in very simplistic terms. He recommended physical therapy and an aspirin each day. Although my mother was polite and seemed attentive within the doctor’s office, on the way home she angrily announced “He didn’t get it right! I’m not doing anything he says – he thinks I’m an idiot, but he’s the idiot.” My mother rejected the diagnosis and the physician’s recommendations, even though both exercise and aspirin therapy are scientifically supported forms of intervention. By failing to acknowledge my mother’s interests, background and knowledge, this physician failed to construct a shared narrative of what happened, why and what to do about it, resulting in wholesale rejection of his recommendations. My mother’s contribution to the unsuccessful interaction was her failure to demand further explanation, and her implicit acquiescence to the “doctor as dominant” style of medical encounter.
