For her article on Doctor/Patient relationships Tara Parker-Pope, she asked me if I had any negative experience with patients and what I thought about the current state of this relationship. I wrote down my thoughts for her (and a quote did appear in the article) and she later suggested it may be a good blog post.
Good idea. I already did the work. So here it is:
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Tara:
I had one case where someone said they were “going to break my head open with a baseball bat.” It was for something very minor – I had seen this guy’s daughter and diagnosed them with an upper respiratory infection and a few days later they were diagnosed with “bronchitis” and given an antibiotic. This is the only case that I recall where they got specifically mad at me. We called the police. We also dismissed the family from the practice (of course). I strongly suspect that the guy had major emotional/psychological problems to begin with.
In general, patients are far more likely to get mad at the staff than at the doctors. I have had patients use profane language to my staff and say that they are going to tell me off when they saw me, only to have them be meek and quiet in the exam room. We have a rule, however, that abusing our staff in any way is a reason for dismissing a patient from the practice.
The most likely patients to get angry and frustrated are those who don’t come in very often. They don’t have much of a relationship with me or my staff, and so they don’t give us the benefit of the doubt when it comes to us running late or mixing things up. They are far more likely to just walk out without being seen.
I have noticed that patients are far more likely to question medical decisions than before. I think the information on the Internet has been a cause of this. Doctors used to be the only source for information on medical problems and what to do, but now our knowledge is de-mystified. We are not as valued for what we know. So when patients come in with pre-conceived ideas about what we should do, they do get perturbed at us for “not listening.” I do my best to explain why I do what I do, but some people are not satisfied until we do what they want.
I wonder if the trust that doctors have of their patients is also eroded. We are far more defensive in how we do things and much less likely to admit when we don’t know things. When doctors are afraid of being sued for any small mistake, they are more guarded in what they tell patients and I think the patients sense it. This is not as much the case in primary care, as I have an ongoing relationship with the majority of my patients, but it does take its toll.
I suspect the payment system has something to do with it. When patients don’t know what we charge for things (we are not allowed to disclose our fee schedules), they assume we are milking the system for all it’s worth. The fact that the majority of transaction happens below the surface devalues the visit. I think this is why many physicians\’ experience is that the Medicaid population (which doesn’t pay at all) is the most demanding, while the self-pay seem to be the least. When you buy something at the store, there is an expectation of higher quality for higher cost. This holds the seller accountable for offering enough value for what they sell. When patients pay a small co-pay (or none at all), there is no financial accountability.
Still, I wonder if there really is an “epidemic of anger” towards doctors. Yes, there are stories of patients attacking doctors, but this may be more a fact that information flows freer than it ever did. It is kind of like how parents are all paranoid about letting their kids play in their yard because they may get abducted by a stranger. The risk is far less than most parents think. Overall, I have had very few negative interactions with my patients.
I hope this helps.
Rob
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There is an interesting video on the blog.
Thoughts?
Rob,
Great post. I think one of the problems may be with this younger generation. I don’t see this type of distrust from the elderly population to speak of. I saw a young man the other day with several days of wheezing, cough and fever. Recommended an Albuterol nebulizer treatment, cxr and then, when no infiltrate was present, steroid injection, medications, etc. He was self pay and had asked me if he could pay the balance at a later date and I agreed. When he left, he got a break at the office, I didn’t even charge him for the Albuterol, I gave him about $200 worth of samples. Do you know what he had the nerve to do? He called back and complained about how ridiculously expensive we were.
I am afraid it is only going to get worse as doctors become “providers” and patients become “consumers.”
Rob,
Great post. I think one of the problems may be with this younger generation. I don’t see this type of distrust from the elderly population to speak of. I saw a young man the other day with several days of wheezing, cough and fever. Recommended an Albuterol nebulizer treatment, cxr and then, when no infiltrate was present, steroid injection, medications, etc. He was self pay and had asked me if he could pay the balance at a later date and I agreed. When he left, he got a break at the office, I didn’t even charge him for the Albuterol, I gave him about $200 worth of samples. Do you know what he had the nerve to do? He called back and complained about how ridiculously expensive we were.
I am afraid it is only going to get worse as doctors become “providers” and patients become “consumers.”
I had a doctor that I really liked, personally. We went to the same junior high (in another state and very small town) and had the same band teacher. Gave us some common ground.
However, I began to notice that she wasn’t proactive, and just dealt with things as they came up. She didn’t know about some of my more serious medications, and it took almost a year for her to ‘get’ that I really did have to have monthly lab work for the high risk meds.
When I realized that I’d had 4 different situations just this year that slipped by (including the cat bite) I realized I needed to think about a change …
SO, I’m wishing my previous doctor would come back from maternity leave (18 months is a long time!!) or the one before that would move back up here from Texas. But ..since neither is happening … new PCP. I’ve been in the same office for 11 years … docs changed on me, but …. I stayed put … till now.
I had a doctor that I really liked, personally. We went to the same junior high (in another state and very small town) and had the same band teacher. Gave us some common ground.
However, I began to notice that she wasn’t proactive, and just dealt with things as they came up. She didn’t know about some of my more serious medications, and it took almost a year for her to ‘get’ that I really did have to have monthly lab work for the high risk meds.
When I realized that I’d had 4 different situations just this year that slipped by (including the cat bite) I realized I needed to think about a change …
SO, I’m wishing my previous doctor would come back from maternity leave (18 months is a long time!!) or the one before that would move back up here from Texas. But ..since neither is happening … new PCP. I’ve been in the same office for 11 years … docs changed on me, but …. I stayed put … till now.
I used to believe doctors were infallible. Ok, close to it, anyhow. But my battle with Cushing’s disease (excuse me for bringing it up again, Dr. Rob, but it’s what I know) tainted my belief in just about all doctors. I won’t go into details. You don’t need that. You didn’t cause it. But, I believe, like all people in all walks of life, there are good and there are not-so-good practitioners. That goes for doctors, too. And I believe a person has to be well-informed and take charge of her medical knowledge in order to prevent inadvertent negligence.
I doubt you trust all auto mechanics, computer repair persons, or hair dressers/barbers. Why should we, as patients, trust all doctors? We can’t. Peggikaye has some excellent points above. Just as you have to have some knowledge about your vehicle, computer and what you think your hair dresser should or shouldn’t do, so should we about our doctors.
I very much understand why doctors would be upset with “know-it-all” patients who don’t listen to them. But perhaps the same is happening in reverse. Isn’t half of medical care actually listening to the patient? And what makes doctors think that we are so stupid we can’t learn, too? (Present company excluded, of course.) Just because I chose a different path in life does not mean I can’t study and learn what they learn. Perhaps I know more than many doctors on some subjects. I guarantee Peggikaye and I do on certain subjects, especially when it comes to our bodies and illnesses.
How often do doctors really read the new research and keep up with new diagnosis and treatment options? I believe the answer is “not nearly enough”. That is why the patient has to research and then find a doctor who has or who is willing to learn. That’s what I did. I found a specialist all the way across the country who knew what was wrong with me. I found a PCP who was/is willing to learn. It’s a good combination, but I suffered a lot until I did. And the delay almost cost me my life. Am I angry. You bet. At you, no. At many doctors I saw in the past? Yes. At doctors in general? I don’t know. I don’t know with whom to be angry. Medical schools? The “system”? What? Who?
What is the answer to the above? I’d love to hear it. I know I’m only seeing it from my side, but no doctor has been willing to share with me from his/her side. I’d like to suggest some posts on that from the doctors on these medical blogs.
(As a sidenote, I have never been disrespectful with any doctor. I have been angry, however. I have never minded paying and always pay what is asked, but I do mind when I don’t get anything for the expense. And that is the difference. I had to learn to be assertive and proactive.)
Respectfully posted.
Robin
I used to believe doctors were infallible. Ok, close to it, anyhow. But my battle with Cushing’s disease (excuse me for bringing it up again, Dr. Rob, but it’s what I know) tainted my belief in just about all doctors. I won’t go into details. You don’t need that. You didn’t cause it. But, I believe, like all people in all walks of life, there are good and there are not-so-good practitioners. That goes for doctors, too. And I believe a person has to be well-informed and take charge of her medical knowledge in order to prevent inadvertent negligence.
I doubt you trust all auto mechanics, computer repair persons, or hair dressers/barbers. Why should we, as patients, trust all doctors? We can’t. Peggikaye has some excellent points above. Just as you have to have some knowledge about your vehicle, computer and what you think your hair dresser should or shouldn’t do, so should we about our doctors.
I very much understand why doctors would be upset with “know-it-all” patients who don’t listen to them. But perhaps the same is happening in reverse. Isn’t half of medical care actually listening to the patient? And what makes doctors think that we are so stupid we can’t learn, too? (Present company excluded, of course.) Just because I chose a different path in life does not mean I can’t study and learn what they learn. Perhaps I know more than many doctors on some subjects. I guarantee Peggikaye and I do on certain subjects, especially when it comes to our bodies and illnesses.
How often do doctors really read the new research and keep up with new diagnosis and treatment options? I believe the answer is “not nearly enough”. That is why the patient has to research and then find a doctor who has or who is willing to learn. That’s what I did. I found a specialist all the way across the country who knew what was wrong with me. I found a PCP who was/is willing to learn. It’s a good combination, but I suffered a lot until I did. And the delay almost cost me my life. Am I angry. You bet. At you, no. At many doctors I saw in the past? Yes. At doctors in general? I don’t know. I don’t know with whom to be angry. Medical schools? The “system”? What? Who?
What is the answer to the above? I’d love to hear it. I know I’m only seeing it from my side, but no doctor has been willing to share with me from his/her side. I’d like to suggest some posts on that from the doctors on these medical blogs.
(As a sidenote, I have never been disrespectful with any doctor. I have been angry, however. I have never minded paying and always pay what is asked, but I do mind when I don’t get anything for the expense. And that is the difference. I had to learn to be assertive and proactive.)
Respectfully posted.
Robin
As a general rule I tend distrust anyone that is incapable of saying that they don’t know or aren’t sure of something or isn’t willing to discuss the reasoning behind a decision.
The medical profession is the only one I know of where it is accepted or even encouraged for doctors to come up with an answer, any answer, even if they have to make something up, in their alotted 10 minutes with the patient.
I have a huge appreciation for people that are so smart that they know their limitations and have the kind of integrity that they will say so. I would prefer “I don’t know” any day over some fast answer like I am the human equivalant of Jeopardy. ” Some visits are easy to call, asthma, sinus infection, 10″ spike in the head… I completely appreciate that.
If you are lucky enough to have a something rare and complicated, you may find that it cannot be diagnosed in one fast visit but it can very easily be explained as a lot of different things if you make something up fast enough. For those doctors, an “I don’t know” would have won my life-time respect and gratitude and would have gotten me to the right doctors a whole lot sooner.
As a general rule I tend distrust anyone that is incapable of saying that they don’t know or aren’t sure of something or isn’t willing to discuss the reasoning behind a decision.
The medical profession is the only one I know of where it is accepted or even encouraged for doctors to come up with an answer, any answer, even if they have to make something up, in their alotted 10 minutes with the patient.
I have a huge appreciation for people that are so smart that they know their limitations and have the kind of integrity that they will say so. I would prefer “I don’t know” any day over some fast answer like I am the human equivalant of Jeopardy. ” Some visits are easy to call, asthma, sinus infection, 10″ spike in the head… I completely appreciate that.
If you are lucky enough to have a something rare and complicated, you may find that it cannot be diagnosed in one fast visit but it can very easily be explained as a lot of different things if you make something up fast enough. For those doctors, an “I don’t know” would have won my life-time respect and gratitude and would have gotten me to the right doctors a whole lot sooner.
[…] are patients mad at their doctors? In comments on my previous post, people expressed real frustration and distrust – mainly from a lack of listening and […]
I don’t think patients are mad at their doctors per se- I think they are frustrated by everything else in their lives, and it spills over into a lot of their interactions with other people.
I think many patients are completely unaware of the challenges facing their HCPs regarding eroding reimbursements, the pressure to do more with less, and the epidemic of lifestyle-related chronic illnesses and the apathy and passivity of patients. Not that office time should be spent educating them, but as background, it may help HCPs to understand the “anger” isn’t personal.
I also think a lot of patients are caught between the waning era of paternalistic medicine and an unrealistic one based on supposed complete self-sufficiency from internet-derived information, which we all know can vary in quality.
These patients may benefit from some carefully-worded, progressive direction from HCPs about their role in the relationship, about reasonable expectations of the HCP and the office staff, and how to enhance the effectiveness of the relationship. HCPs may want to develop handouts for patients regarding what to bring to appointments, what questions to ask, what to expect, etc.
Offer the patient pen and paper to write down things during an appointment, or write out instructions for them (or prepare a boilerplate form that can be filled in during the appointment). This act conveys a level of caring beyond what can be expressed at the time, and may ease anxiety because the patient is not trying to remember everything they’re hearing.
If we seem angry, it is likely because we don’t understand what’s going on or why things are done a certain way. Helping us understand these things can go a long way toward developing more functional HCP-patient relations, creating a more rewarding experience for the HCP, and helping patients achieve better outcomes.
I don’t think patients are mad at their doctors per se- I think they are frustrated by everything else in their lives, and it spills over into a lot of their interactions with other people.
I think many patients are completely unaware of the challenges facing their HCPs regarding eroding reimbursements, the pressure to do more with less, and the epidemic of lifestyle-related chronic illnesses and the apathy and passivity of patients. Not that office time should be spent educating them, but as background, it may help HCPs to understand the “anger” isn’t personal.
I also think a lot of patients are caught between the waning era of paternalistic medicine and an unrealistic one based on supposed complete self-sufficiency from internet-derived information, which we all know can vary in quality.
These patients may benefit from some carefully-worded, progressive direction from HCPs about their role in the relationship, about reasonable expectations of the HCP and the office staff, and how to enhance the effectiveness of the relationship. HCPs may want to develop handouts for patients regarding what to bring to appointments, what questions to ask, what to expect, etc.
Offer the patient pen and paper to write down things during an appointment, or write out instructions for them (or prepare a boilerplate form that can be filled in during the appointment). This act conveys a level of caring beyond what can be expressed at the time, and may ease anxiety because the patient is not trying to remember everything they’re hearing.
If we seem angry, it is likely because we don’t understand what’s going on or why things are done a certain way. Helping us understand these things can go a long way toward developing more functional HCP-patient relations, creating a more rewarding experience for the HCP, and helping patients achieve better outcomes.
Also, and here’s a biggie: Let us know what you expect of us. Use plain, direct language tailored to the patient. My ears perk up and I pay attention when, at the end of an office visit, my doc says, “OK, so here’s what you’re going to do: [A, B, C]” and then he checks to make sure I understand.
Tell us what behaviors you expect of us after the visit is over, between visits, and over the long-term. Tell us what to bring to the next visit. Ask us to reiterate what you’ve told us to make sure we understand.
For those of us who get information from the internet, provide us with a list of sources you prefer we use and why.
Help us help you.
Also, and here’s a biggie: Let us know what you expect of us. Use plain, direct language tailored to the patient. My ears perk up and I pay attention when, at the end of an office visit, my doc says, “OK, so here’s what you’re going to do: [A, B, C]” and then he checks to make sure I understand.
Tell us what behaviors you expect of us after the visit is over, between visits, and over the long-term. Tell us what to bring to the next visit. Ask us to reiterate what you’ve told us to make sure we understand.
For those of us who get information from the internet, provide us with a list of sources you prefer we use and why.
Help us help you.
MM, I know doctors deal with a lot we patients don’t know about. Frankly, we shouldn’t have to. The doctors don’t want to know about everything I deal with outside of my illness(es) either. Nor do I want to know what my auto mechanic goes through to get rid of those old tires and that messy oil he drains. That’s why I pay him. So he can deal with it.
As for internet sources, I pay for my sources. I use reputable medical research and journals. There are a lot of poor sites on the internet that look good, for sure. But there are a lot of wonderful sites that are done by good folks. Mayo, Harvard, Vanderbilt and more host some great medical information. Anyone can use the NIH information, too. ANd more…..
If I bring my information in, will you read it? The reason I kept my PCP is because she will. And she’ll let me email it to her, too. My endo actually gives me research to read and will read what I find. But do you know how long it took me to find those two?
So, how do we have a meeting of the minds? How do I help my doctors be better doctors with their limitations due to all you mentioned? And how do they help me get better with all the limitations?
Million dollar question, eh?
MM, I know doctors deal with a lot we patients don’t know about. Frankly, we shouldn’t have to. The doctors don’t want to know about everything I deal with outside of my illness(es) either. Nor do I want to know what my auto mechanic goes through to get rid of those old tires and that messy oil he drains. That’s why I pay him. So he can deal with it.
As for internet sources, I pay for my sources. I use reputable medical research and journals. There are a lot of poor sites on the internet that look good, for sure. But there are a lot of wonderful sites that are done by good folks. Mayo, Harvard, Vanderbilt and more host some great medical information. Anyone can use the NIH information, too. ANd more…..
If I bring my information in, will you read it? The reason I kept my PCP is because she will. And she’ll let me email it to her, too. My endo actually gives me research to read and will read what I find. But do you know how long it took me to find those two?
So, how do we have a meeting of the minds? How do I help my doctors be better doctors with their limitations due to all you mentioned? And how do they help me get better with all the limitations?
Million dollar question, eh?
I am just now going through a situation with my doctor. I had made a simple request for hormones/birth control to lessen my heavy periods. I am 49 years young and have always had heavy periods and I just wanted a small amount of calm in my otherwise insane life. My doctor only half listened to me and decided I was having abnormal periods. She went off the deep end and started ordering all of these test including an ultrasound.I am a self paying consumer at the doctors office and I can’t afford all of these tests, so I decided to just deal with my periods as they are for the next few years until menopause is here. This was not good enough for my doctor.
In a recent visit to see her for an entirely different reason she told me “this appointment is a waste of time until you get these tests”. She wasn’t even totally into the room when she said it. I tried to explain the situation, but she wouldn’t listen. She just added an endometrial biopsy to the list of tests she wants me to have.
I am fed up with trying to get her to listen to me so I am looking for a new doctor. I just wish I had never mentioned anything to her in the first place.
I am just now going through a situation with my doctor. I had made a simple request for hormones/birth control to lessen my heavy periods. I am 49 years young and have always had heavy periods and I just wanted a small amount of calm in my otherwise insane life. My doctor only half listened to me and decided I was having abnormal periods. She went off the deep end and started ordering all of these test including an ultrasound.I am a self paying consumer at the doctors office and I can’t afford all of these tests, so I decided to just deal with my periods as they are for the next few years until menopause is here. This was not good enough for my doctor.
In a recent visit to see her for an entirely different reason she told me “this appointment is a waste of time until you get these tests”. She wasn’t even totally into the room when she said it. I tried to explain the situation, but she wouldn’t listen. She just added an endometrial biopsy to the list of tests she wants me to have.
I am fed up with trying to get her to listen to me so I am looking for a new doctor. I just wish I had never mentioned anything to her in the first place.