Making Patients Angry

I was talking today with a specialist friend (yes I do have them) today and we were talking about a patient of mine whom he had angered. He is one of the gentler people I know, so when I got the irate call from the patient about his care, I had a good idea what was up. He had refused to give her a pain medication and felt "like he didn\’t care."

In talking with him, he had taken her pain very seriously, but feels (as I do) that people should only be getting narcotics from one source. Since it is a common ploy of the "drug seeker" to go to different doctors for narcotics, we generally try to make sure only one of us is prescribing them. I would have done the same thing, and appreciate his conscientious approach.

He was somewhat apologetic about making her mad, but I told him not to worry. I have always believed that if you are not making people angry, you are probably doing something wrong (at least as it relates to the practice of medicine). We get demands made on us daily, some of which are not reasonable. Some of the more frequent unreasonable requests are:

• Excessive narcotics requests.
  If I could get rid of prescribing narcotics, I would. While you want to take people\’s pain seriously and treat it appropriately, you often feel you are being used by people to supply their habit. I think narcotics have a big place – when I had pain from my gall bladder, I was very thankful for the narcotic I got in the ER. People with chronic pain is much harder. I try to treat it with as few narcotics as possible, but there is no way to avoid giving them if you are the sympathetic sort as I am. This ends up being a constant inner struggle as a physician between being firm and seemingly cold-hearted, and being sympathetic and feeling like you are being used. The only way to avoid making people angry at you in this situation is to freely prescribe narcotics at a level that would probably get you an appointment with the DEA.
• Patients coming to the front desk and demanding to be seen immediately.
  I generally keep a very full schedule several days (sometimes weeks) in advance. When people come to my office or call demanding to be seen, they put their needs ahead of the people on my schedule. Certainly, if someone has a pressing medical need (having a seizure or in respiratory distress) I will drop what I am doing to help them. The problem is that these demands usually are not emergencies. In this case I generally refuse to give into the demands and instead have a nurse talk to them to see what the problem is.
  I had one patient who was a doctor who would repeatedly call demanding to talk to me now. At first I answered his calls, thinking he knew the time pressures of a doctor\’s office; but eventually I stopped answering them immediately and he was infuriated and went somewhere else. As far as I was concerned, I was happy to see him go, because there is no way I could meet his demands.
• Requests to "fudge" prescriptions.
  I am a stickler when it comes to how prescriptions are written. When people ask for me to write for a pill twice a day when they will only take one, or even a whole pill, when they take only half, I tell them I won\’t do it. I also get occasional requests to write prescriptions to a family member\’s name who has insurance so they can get the drug cheaper. I can generally avoid angering them too much by explaining that they are requesting I commit insurance fraud, and that I could lose my license for doing it. Still, it always bothers me that people will assume I can cheat for them.
• Requests to call in Antibiotics.
  People are sure they have a sinus infection or positive they have strep throat. We try not to over-prescribe antibiotics, so we usually make people come in to get them. The only exception is the family member of someone we diagnosed with strep throat who comes up with the same symptoms. I find that even when patients had self-diagnosed correctly, there are often reasons why it was a good idea for them to come in (blood pressure up, wheezing, etc.).
• Requests for refills without coming in to be seen.
  We will refill medications over the phone, but request that people come in on a regular basis. The frequency of the visits depends on the medical condition: 1 year for the hypothyroid patient, 6 months for the hypertensive patient and 4 months for the diabetic. They often get angry at my staff for requiring follow-up visits, acting like we bring them in so we can get their money. We had one diabetic man who would only come in when we stopped prescribing his Viagra for him. This is not blackmail, however, it is simply good care. I am far too busy to have to generate unnecessary office visits.
• Desires for long phone "consultations."
  I have to confess that I am a little bit of a "phone-o-phobe." I don\’t like talking on the phone anyhow, and probably dump too many phone calls on my nurses. But my heart always sinks when I get the message that someone needs to "talk with me personally" and won\’t say why. It usually ends up being a 20+ minute phone call. If something is that important, why can\’t they come in and talk to me about it, or why can\’t they at least try to talk with my nurse about it?

I have to fight the people-pleaser in me that wants all of my patients to be happy all the time. Most doctors went into medicine partly because of the fact that they could help people; it goes against our grain to make people angry. Add to this the desire to "keep the customer satisfied" and there is a strong temptation to give in to the unreasonable demands thrust upon us daily. It is easy to give in, but overall I have found that being willing to anger patients when necessary will make your life a whole lot better as a physician.

By the way, 2 points for anyone who can explain the inclusion of the picture at the top of this post.