Someone suggested I was being mean or making fun of patients in my previous post. Those of you who read this blog regularly (aside from needing serious psychiatric evaluation) are aware that I am quite sympathetic of my patients\’ position in this relationship. Mine is a position of power, while they are coming to me with an admission of weakness. There is no doubt that I would rather sit in the doctor\’s chair than that of the patient – and that\’s not just because my chair has wheels on it.
My intent in writing this blog is to show the doctor/patient interaction through the eyes of a physician – a perspective most people don\’t get very often. Even though I have lots to be thankful for in my profession, I still have things that regularly annoy me. For me to voice that annoyance in a light manner is meant to both educate people of my perspective, and entertain those who share it.
Enough of that. Now it\’s time to move on to the strategies we physicians use to get back at patients for their shenanigans. You may not realize it, but we have a special class in medical school dedicated solely to the ways to annoy and embarrass our patients. It\’s an art, really.
Here\’s my list:
1. Require ridiculous paperwork
At every visit, a patient should be required to fill out paperwork that captures information that they have provided at every previous visit. Certainly it makes sense to ask if a person has changed insurance since the last visit, and wanting an updated medication and allergy list is good practice. The true art, though, is in asking questions like: \”Has your mother\’s maiden name changed since your last visit?\” or \”Please list all medications (including over-the-counter) that you have taken over the last 3 years?\”
2. Waiting Room Lottery
Being called from the waiting room to the exam room should not depend on when each person arrived; it should be totally random. Few things frustrate as much as seeing someone who clearly came in after you get called back before you. It is quite fun to watch the reactions of people when others are called before they are. Many office staffs take bets on who will be the first to erupt.
3. Use a complicated and unreliable voicemail system
It is unacceptable for people to be able to actually talk to humans unless they have spent a minimum of 15 minutes meandering through the voicemail system. The reason for this are as follows:
- It weeds out people who aren\’t all that sick as well as those who are not going to be dedicated patients.
- It increases the volume of patients coming in with high blood pressure and ulcers.
- It creates a convenient scape goat if anything goes wrong. \”Dang. It must be our lousy voicemail system again…\”
4. Have unreasonable rules
Patients who are more than 30 seconds late for their appointment must be made to reschedule, and that appointment should be a minimum of two weeks after the missed appointment. We only hope that patients don\’t notice it when we are 45 minutes late to see them…. Charging $10 per page for people to get their own records is another way to create fury. It\’s good fun.
5. Use the scale strategically
The scale in a doctor\’s office is a powerful weapon that should be wielded with skill. Many patients are as nervous to stand on the scale as they are coming to the doctor in the first place. Increasing weight should always lead to a lecture about the dangers of obesity, and the weight on the scale should always be set to read at least 10 pounds more than is accurate. Having the scale in a public place or having a staff member with a very loud voice can increase the trauma the scale can inflict. Always check blood pressure immediately after weighing the patient, as the inevitable high reading can give extra fodder for lectures on the dangers of obesity.
6. Lecture
\”Do you realize smoking is bad for you?\” That is one of my all-time favorites. It assumes that the patient has missed the news about cigarettes not being a fountain of youth. Perhaps they haven\’t discovered that newfangled invention called television. But lectures about the dangers of cigarette smoking, heavy drinking, or poor eating habits should not happen once – most patients expect that to happen; they should be given every visit, even the ones that have nothing to do with these vices. Have a foot fungus? Expect a lecture about not exercising.
7. Look frazzled
Some doctors are masters at always entering a room looking harried and rushed, which makes the patient feel guilty about burdening the doctor any more. It really is bothersome for these patients to come with so many problems. Giving a pained expression when the person starts talking about things is sure to shorten the visit. So what if they are paying to be seen, the doctor is having a bad day and they should be nice to him!
8. Don\’t explain much
Prescribing medications or ordering numerous tests is part of the job. We are paid to make all the decisions and patients should trust us! Why should we have to explain to our patients why they should take the medication we give? Why should they know the purpose of having a cholesterol rechecked every 3 months? Leaving patients a little unsure about why tests are ordered will keep them from asking those pesky questions about interpretation. Just tell them that \”it looks fine\” and that should be enough.
9. Tell them there is \”nothing wrong\”
The baby was up all night screaming with a temperature up to 103. Yet when they come into the office, the child looks fine and is sleeping…like a baby. The best response from the doctor is to look at the parent with a \”Why did you bring a healthy child in to see me? Why are you wasting my valuable time?\” expression. Look the child over and declare the child healthy. The fever and screaming are probably things the parents just made up to get attention; either that or they were hallucinating.
10. Always somehow relate their condition to a mental health issue
Relating all problems to depression or \”stress\” is a great way to put patients in a difficult position. Assuming it before any tests are run is even better. \”I know how hard things have been for you over the past few months\” is a good way to get things going. The chest pain is probably hysteria of some sort and a good prescription of Zoloft will clearly make things get better. This allows everything the patient says to be taken lightly, as it all represents part of their defense mechanisms in dealing with their mental problem.
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This was actually a little harder to write than I expected. I didn\’t want to sound too harsh or cynical, but it kept coming out that way. I am sure many people will have more to add. I really do think there is a long legacy of doctors being in charge of the relationship and so abusing their status to patronize patients. Thankfully, this is a legacy of the past and is hopefully becoming less common. I do still, however, hear things that doctors do that make me wince with a disturbing frequency.
For all of the idiot doctors out there I offer my deepest apologies. Don\’t take it. Leave them and put them out of business if they don\’t clean up their act.
Corollary to 10- mental health docs must always make mental health problems a medical issue. Feeling depressed? Lets check you for anemia, thyroid problems, Cushing’s disease, and lets get a whole body scan while we’re at it, before continuing the Zoloft your PCP already gave you.
Those who hate labwork get extra.
Corollary to 10- mental health docs must always make mental health problems a medical issue. Feeling depressed? Lets check you for anemia, thyroid problems, Cushing’s disease, and lets get a whole body scan while we’re at it, before continuing the Zoloft your PCP already gave you.
Those who hate labwork get extra.
Love the post. Follows on beatifully from mine this time last year on how to irritate your clinicianhttp://tinyurl.com/5urpd9
and how to irritate your patients
http://tinyurl.com/58rj79
Wow. It makes me nervous. Honest, I didn’t steal the idea. Great minds….
Love the post. Follows on beatifully from mine this time last year on how to irritate your clinicianhttp://tinyurl.com/5urpd9
and how to irritate your patients
http://tinyurl.com/58rj79
Wow. It makes me nervous. Honest, I didn’t steal the idea. Great minds….
I guess I’ve lost my sense of humor. I’ve had to leave doctors who have done most of the things on the list. Changing doctors is not fun. I’ve had a very few physicians that I really looked forward to seeing. Most are way too busy. Some are not competent.
I guess I’ve lost my sense of humor. I’ve had to leave doctors who have done most of the things on the list. Changing doctors is not fun. I’ve had a very few physicians that I really looked forward to seeing. Most are way too busy. Some are not competent.
Witty and insightful, as usual!
Witty and insightful, as usual!
Wow… way to touch on the things docs do that peeve me most. I’d have to say my personal #1 was when the doc came into the room 35 minutes late and introduced herself by telling me that she was really behind and had other people waiting. I’d never met her before, and I hadn’t even opened my mouth yet.
I think your 9 and 10 are pretty closely related… “I don’t think there’s anything wrong with you, so it’s probably all just in your head… I mean, I know it’s real to YOU, but you’re basically just wasting my time with your anxiety problems. This isn’t a medical issue, so take some zoloft and get out of my hair.” …not that I’ve ever heard THAT before…
Most of the others seem more like administrative/staff issues and not really things the doc himself does. Still, I’m glad you’re aware and care enough to realize that things like this do make patients crazy. Hopefully anyone in the field will be able to keep this perspective in mind (including me!).
Thanks for the post.
I agree that 9 and 10 are similar, but 9 is often done due more to cluelessness. Docs finish their job and feel like they have ruled out the important stuff. To them, “Nothing is wrong” means that all of the scary diagnoses are not in play. The doc, however, fails to empathize with the patient who is stuck with the symptoms and is wondering what is going on. “Nothing is wrong” is a big blow to people who are already self-conscious. I’ve seen it a lot, but cluelessness is usually the root.
Wow… way to touch on the things docs do that peeve me most. I’d have to say my personal #1 was when the doc came into the room 35 minutes late and introduced herself by telling me that she was really behind and had other people waiting. I’d never met her before, and I hadn’t even opened my mouth yet.
I think your 9 and 10 are pretty closely related… “I don’t think there’s anything wrong with you, so it’s probably all just in your head… I mean, I know it’s real to YOU, but you’re basically just wasting my time with your anxiety problems. This isn’t a medical issue, so take some zoloft and get out of my hair.” …not that I’ve ever heard THAT before…
Most of the others seem more like administrative/staff issues and not really things the doc himself does. Still, I’m glad you’re aware and care enough to realize that things like this do make patients crazy. Hopefully anyone in the field will be able to keep this perspective in mind (including me!).
Thanks for the post.
I agree that 9 and 10 are similar, but 9 is often done due more to cluelessness. Docs finish their job and feel like they have ruled out the important stuff. To them, “Nothing is wrong” means that all of the scary diagnoses are not in play. The doc, however, fails to empathize with the patient who is stuck with the symptoms and is wondering what is going on. “Nothing is wrong” is a big blow to people who are already self-conscious. I’ve seen it a lot, but cluelessness is usually the root.
loved your posts! They were both spot-on, as usual!
the top way docs and their office staff annoy me is to NOT wash their hands or use any hand gel in my presence, and then lay their hands on me. Or, to grab gloves with their not-washed hands and put them on, to do things to me. Who are they protecting, me or themselves? Obviously, neither, since once gloves are touched with un-washed hands, they are not clean.
And for any mis-guided staff who would declare, “Well, i just washed them before i came in!” Phhffttt! Yes, maybe so (altho i doubt it) — but then you touched the chart, the doorknob, and the computer keyboard. All unclean.
Come on, folk — we all know the rules. We all know about the benefits of handwashing. Just do it!
AND… please introduce yourself with your title/position in a clear voice, if we do not already know you well. You have our chart, and know our name — but we often don’t know you. Your name tags are either turned around or too small to read. We don’t know whether we are talking to the medical assistant, PA, licensed nurse, insurance person, or cleaning lady.
grrrrr…….
I keep hand sanitizer in the room for that reason. I think I am not getting sick as often since I started doing that.
loved your posts! They were both spot-on, as usual!
the top way docs and their office staff annoy me is to NOT wash their hands or use any hand gel in my presence, and then lay their hands on me. Or, to grab gloves with their not-washed hands and put them on, to do things to me. Who are they protecting, me or themselves? Obviously, neither, since once gloves are touched with un-washed hands, they are not clean.
And for any mis-guided staff who would declare, “Well, i just washed them before i came in!” Phhffttt! Yes, maybe so (altho i doubt it) — but then you touched the chart, the doorknob, and the computer keyboard. All unclean.
Come on, folk — we all know the rules. We all know about the benefits of handwashing. Just do it!
AND… please introduce yourself with your title/position in a clear voice, if we do not already know you well. You have our chart, and know our name — but we often don’t know you. Your name tags are either turned around or too small to read. We don’t know whether we are talking to the medical assistant, PA, licensed nurse, insurance person, or cleaning lady.
grrrrr…….
I keep hand sanitizer in the room for that reason. I think I am not getting sick as often since I started doing that.
if the patient tells you they drink 1 glass of red wine with dinner every night, begin the CAGE questionnaire:have you ever thought you should Cut down on drinking? have you ever been Annoyed when people criticize your drinking? do you ever feel Guilty about your drinking? do you ever have an Eye-opener first this in the morning?
all four questions must be asked exactly right and the answers written down and given a numeric score.
be sure and characterize their glass of red wine (which you recommended for their heart 2 years ago) as “your drinking.”
bonus points: if this occurs in the context of a hospital admission, order the nurses to administer an alcohol-withdrawal exam every day during the admission, examining for hand tremor, asking if they are hallucinating, etc.
if the patient tells you they drink 1 glass of red wine with dinner every night, begin the CAGE questionnaire:have you ever thought you should Cut down on drinking? have you ever been Annoyed when people criticize your drinking? do you ever feel Guilty about your drinking? do you ever have an Eye-opener first this in the morning?
all four questions must be asked exactly right and the answers written down and given a numeric score.
be sure and characterize their glass of red wine (which you recommended for their heart 2 years ago) as “your drinking.”
bonus points: if this occurs in the context of a hospital admission, order the nurses to administer an alcohol-withdrawal exam every day during the admission, examining for hand tremor, asking if they are hallucinating, etc.
Ha! very witty post! Def can identify with the “chalk it up to mental state” diagnosis. Even though it might be true, how the heck can you contest that?? My Number one annoyance – hands down- is when a doctor laughs at me. i mean i know people gotta laugh in their day jobs, but really, is it really appropriate to show amusement at my weight gain over the last year? cant you wait til your in the break room or something?Oh also, when I was 16, I went to a gyn who smirked when I told her that I had never had sex. Smirked for gosh sakes! As if I wasn’t self-conscious enough about that!
The website I’m working on just did a video about the doctor-patient relationship, (in this case the pt annoys his doctor). but would love to hear your thoughts! http://speakhealth.org/a-doctors-dilemma/
~c
Ha! very witty post! Def can identify with the “chalk it up to mental state” diagnosis. Even though it might be true, how the heck can you contest that?? My Number one annoyance – hands down- is when a doctor laughs at me. i mean i know people gotta laugh in their day jobs, but really, is it really appropriate to show amusement at my weight gain over the last year? cant you wait til your in the break room or something?Oh also, when I was 16, I went to a gyn who smirked when I told her that I had never had sex. Smirked for gosh sakes! As if I wasn’t self-conscious enough about that!
The website I’m working on just did a video about the doctor-patient relationship, (in this case the pt annoys his doctor). but would love to hear your thoughts! http://speakhealth.org/a-doctors-dilemma/
~c
Don’t forget the tried & true classic:
“The MD pays more attention to the MD’s watch, constantly and obviously, than to the patient as the pt discusses whatever problem brought them to see the doc in the first place. The quickly whip out a scrip for the latest blockbuster drug, whether indicated or not, pat the pt on the back, wave off any concerns over side effects, and leave the exam room all within 5 minutes.
Don’t forget the tried & true classic:
“The MD pays more attention to the MD’s watch, constantly and obviously, than to the patient as the pt discusses whatever problem brought them to see the doc in the first place. The quickly whip out a scrip for the latest blockbuster drug, whether indicated or not, pat the pt on the back, wave off any concerns over side effects, and leave the exam room all within 5 minutes.
I choose to take this as official confirmation of what I already knew, namely that my doctor’s scale weighs 10 pounds heavy and that he does this on purpose. Jerk.
I choose to take this as official confirmation of what I already knew, namely that my doctor’s scale weighs 10 pounds heavy and that he does this on purpose. Jerk.
You remind me of the Happy Hospitalist
You remind me of the Happy Hospitalist
You left off my favorite – make a patient wait an hour for the first appointment on the books, especially if it’s just a shot. Bonus points if there’s no explanation.
(and this was a nurse visit appointment at a non-emergency clinic with about 20 nurses on staff. I appreciate that stuff happens, but the only thing I could come up with was an emergency staff meeting.)
You left off my favorite – make a patient wait an hour for the first appointment on the books, especially if it’s just a shot. Bonus points if there’s no explanation.
(and this was a nurse visit appointment at a non-emergency clinic with about 20 nurses on staff. I appreciate that stuff happens, but the only thing I could come up with was an emergency staff meeting.)
Another addition to the list – you’ve seen the same doctor twice a year for 3 years running and yet you know they don’t even vaguely recognize you when they see you. It’s like when you’re at a social event and you have to embarrassingly remind the person who’s just introduced themselves to you that you’ve already met — for the 7th time.
Well…some of that hits personally to me. I have 3000 patients and they each have one doctor. I am seen by many people who recognize me but I don’t recognize them – it happens in public places and I hate it. Your doctor probably hates it too. If he/she’s like me at least.
Another addition to the list – you’ve seen the same doctor twice a year for 3 years running and yet you know they don’t even vaguely recognize you when they see you. It’s like when you’re at a social event and you have to embarrassingly remind the person who’s just introduced themselves to you that you’ve already met — for the 7th time.
Well…some of that hits personally to me. I have 3000 patients and they each have one doctor. I am seen by many people who recognize me but I don’t recognize them – it happens in public places and I hate it. Your doctor probably hates it too. If he/she’s like me at least.
ha! re: number 6… my brother has always tended toward being overweight. He’s 6’1″ and I don’t know how much he weighs but he was always the chubby kid, he wore “husky” sizes, and as an adult, he’s usually between 20-40 lbs overweight. We used to have a family doctor who was obsessed with weight. Every time my brother went in, Dr. C would say “You know, you should really take off a few pounds.” I remember when my brother went to see the doc with what turned out to be severe, hospitalization-worthy campylobacteriosis. The doctor told him he was going to admit him, and “by the way – maybe this is good, it’ll jump-start your weight loss. You still need to take off a few pounds.” My mother was incensed. As a college student, my brother severely injured his finger in an exercise bike accident of some kind. He went to this same doc, who walked into the room, looked at the mangled finger, and said “well, we’re going to send you for x-ray. You should also take off a few pounds.” At that point my brother said “screw you,” and found a new doctor.
ha! re: number 6… my brother has always tended toward being overweight. He’s 6’1″ and I don’t know how much he weighs but he was always the chubby kid, he wore “husky” sizes, and as an adult, he’s usually between 20-40 lbs overweight. We used to have a family doctor who was obsessed with weight. Every time my brother went in, Dr. C would say “You know, you should really take off a few pounds.” I remember when my brother went to see the doc with what turned out to be severe, hospitalization-worthy campylobacteriosis. The doctor told him he was going to admit him, and “by the way – maybe this is good, it’ll jump-start your weight loss. You still need to take off a few pounds.” My mother was incensed. As a college student, my brother severely injured his finger in an exercise bike accident of some kind. He went to this same doc, who walked into the room, looked at the mangled finger, and said “well, we’re going to send you for x-ray. You should also take off a few pounds.” At that point my brother said “screw you,” and found a new doctor.
Very well written. Makes me appreciate my doctors even more, because they don’t typically do these things.
Very well written. Makes me appreciate my doctors even more, because they don’t typically do these things.
Very interesting article. These would definitely be signs that you should change doctors. I’m reading an interesting book on the subject of doctor- patient relationships. It’s called “Time to Care” by Norman Makous, M.D. It advocates that this relationship is a critical part of understanding the patient’s medical situation, making a diagnosis, and applying effective treatment. One thing that is wonderful about “Time to Care” is the fact that Dr. Makous really kept that old-fashioned, personal style as a doctor, despite all of the modern changes going on around him.His patients obviously loved him. http://normanmakous.com/
Very interesting article. These would definitely be signs that you should change doctors. I’m reading an interesting book on the subject of doctor- patient relationships. It’s called “Time to Care” by Norman Makous, M.D. It advocates that this relationship is a critical part of understanding the patient’s medical situation, making a diagnosis, and applying effective treatment. One thing that is wonderful about “Time to Care” is the fact that Dr. Makous really kept that old-fashioned, personal style as a doctor, despite all of the modern changes going on around him.His patients obviously loved him. http://normanmakous.com/
As a medical transcriptionist I work closely with providers and I see (and mostly hear) a lot of what transpires. There are really good providers and some who definitely missed their calling. To be fair, there are a large numbers of patients who…um… are not the easiest to have a doctor/patient relationship with. (One particularly malodorous patient comes to mind…. ) I am thankful for my PCP who has a great sense of humor and knows what she’s doing. 🙂
As a medical transcriptionist I work closely with providers and I see (and mostly hear) a lot of what transpires. There are really good providers and some who definitely missed their calling. To be fair, there are a large numbers of patients who…um… are not the easiest to have a doctor/patient relationship with. (One particularly malodorous patient comes to mind…. ) I am thankful for my PCP who has a great sense of humor and knows what she’s doing. 🙂
My favorite story comes from when I had undiagnosed IBS. I could hardly eat anything without extreme pain and diarrhea. When I called the GI specialist’s office, they told me I would have to wait three months to see her, as she was booked solid until then. Great. Then, once I saw her, she scheduled some tests for me. I went in for the tests. When I called to ask when I could talk to her about the results? Yep, three months. Three months of pain, not to mention anxiety and depression about not being able to eat anything. The best part was that sometimes when I would call for an appointment, they wouldn’t let me make one at all, because all the months they had on their calendar were booked, and they weren’t allowed to start making appointments for the next month yet. They would tell me to call back next month.
And then of course when I did see her, she only talked to me for five minutes. I’ve been to see a lot of doctors in the past couple of years, and invariably, the nurses are always kind and personable, and the doctors are cold and brusque. Something needs to change about the way we get health care.
Sophie: It sounds like you have gotten a bad bunch. I don’t hear much of that kind of thing and if one of my patients had that experience with a specialist, I would stop sending people to them. PCP’s do have some power in that circumstance. Having a good PCP is a really important thing.
My favorite story comes from when I had undiagnosed IBS. I could hardly eat anything without extreme pain and diarrhea. When I called the GI specialist’s office, they told me I would have to wait three months to see her, as she was booked solid until then. Great. Then, once I saw her, she scheduled some tests for me. I went in for the tests. When I called to ask when I could talk to her about the results? Yep, three months. Three months of pain, not to mention anxiety and depression about not being able to eat anything. The best part was that sometimes when I would call for an appointment, they wouldn’t let me make one at all, because all the months they had on their calendar were booked, and they weren’t allowed to start making appointments for the next month yet. They would tell me to call back next month.
And then of course when I did see her, she only talked to me for five minutes. I’ve been to see a lot of doctors in the past couple of years, and invariably, the nurses are always kind and personable, and the doctors are cold and brusque. Something needs to change about the way we get health care.
Sophie: It sounds like you have gotten a bad bunch. I don’t hear much of that kind of thing and if one of my patients had that experience with a specialist, I would stop sending people to them. PCP’s do have some power in that circumstance. Having a good PCP is a really important thing.
I share Hillary’s sentiments about a very, very late physician and no acknowledgement by the doctor or the staff. Disrespectful to say the least.
I share Hillary’s sentiments about a very, very late physician and no acknowledgement by the doctor or the staff. Disrespectful to say the least.
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Like it. Really funny, a little true.. sometimes very true..Still funny.