The next part of the NY Times’ excellent “On being a patient” series: Why doctors’ don’t listen.

Ms. Wong had come across a bane of the medical profession: the difficult doctor. These doctors may be arrogant or rude, highhanded or dismissive. They drive away patients who need help, and some have been magnets for malpractice claims.

And while such doctors have always been part of medicine, medical organizations say they fear that they are increasingly common – doctors, under pressure to see more patients, are spending less and less time with each one and are replacing long discussions with laboratory tests and scans – and that most problem doctors apparently have no idea of their patients’ opinions of them.

Patients usually do not confront doctors. Instead, most rant to friends or family members about their experiences or simply change doctors. But in most areas of the country, there is an abundance of patients. If a few patients leave a medical practice, plenty more can take their place, so doctors may never even know what their patients think.

Pretty easy to see why. Doctors are rewarded (i.e. paid) by quantity. There is incentive to order tests and perform procedures rather than spending time with the patient. With Medicare reimbursements being pressured daily, the government is essentially forcing doctors to practice conveyor-belt medicine.

Fix the reimbursement system, and you’ll see these communication problems magically vanish.

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  • Anonymous

    Well, in the first example in the article the doctor didn’t tell a woman she had hipatitus A. Instead he said her she had a virus and refused to answer what kind of virus it was.
    Does it take longer to tell “you have hipatitus A” than to tell “you a have a virus” and then have to listen to another question? It seems that the former thakes less time than the latter.

  • Anonymous

    “Hipatitis”? – Naw, that topic is over at Gruntdocs.

    The hepatitis doc figured he could would try and get away with not explaining his patient’s condition, prognosis and treatment. If you give a mouse a cookie…

    Seriously, I’d complain to the board of medicine AND the board of health, if that were my physician.

    Hepatitis A is contagious and a reportable disease… Where was her warning to avoid sharing utensils or to avoid food preparation for others? People in close contact with her were at risk of infection. Her contacts could be immunized…

    If you are too damn lazy to tell a patient what’s wrong with them, your fellow physians shouldn’t want you associatied with the profession.

  • Anonymous

    “With Medicare reimbursements being pressured daily, the government is essentially forcing doctors to practice conveyor-belt medicine.”

    No one if “forcing” physicians to do anything. They choose to accept Medicare. They choose to see so many patients to make X amount of money.

  • Anonymous

    Wouldn’t do any good. The other insurance companies follow medicare’s lead and reimburse in the same idiotic fashion.

  • Anonymous

    Are you required to take insurance? No one is forcing you to do so. If you guys showed half the organization you do in fighting on BEHALF of the insurers against victims in any other endeavor, you might actually achieve something.

  • Anonymous

    “Why Doctors Don’t Listen”

    I know a lot of doctors where I work who are good listeners, and communicate very well. There is a handful of doctors who are not and most of us know who they are and we hear this from patients and nurses or friends. It is this few uncaring doctors who give doctors a bad name. At least this is my biased observation where I work. I suspect that the majority of doctors listen and communicate well with their patients. There are a few doctors who don’t and it’s not surprising that the same ones get sued more often.

  • Anonymous

    Doctors dont have a choice on whether to accept insurance or not.

    Medicare controls 50% of all healthcare dollars in the USA.

    insurance companies as a whole (including Medicare) comprise over 95% of the healthcare market.

    Doctors dont have a choice on whether they want to accept insurance or not, because they are the only game in town.

  • gasman

    I am a practicing physician. I agree that communication can often be poor.

    But, as long as patients crowd waiting rooms then physicians with poor communication skills continue to be rewarded. Come on patients, vote with your feet. Any boorish behavior that is tollerated cannot be claimed to be intollerable.

  • Anonymous

    Voting with their feet is just what the patient’s in the article did…

    But ideally the doctor and his employer’s/partners would be made aware of his specific shortcomings.

    The doc who didn’t even tell his patient she had hepatitis ought to be disciplined, that’s a dangerous and unconscionable action on his part that put the health of the PUBLIC at risk, not just his patient.

    I work around some communication problems by always getting a copy of my labs and exam notes a day or two after the visit (when results have come back.)

  • Anonymous

    So you have one particular patient relating an encounter with a physician that didn’t agree with them and you have concluded that all or most of that physician’s encounters are the same? He didn’t get along with me, so he must be a “difficult physician”.

    Doesn’t make a lot of sense to me. At least not any more than anyone else relating a disagreeable encounter and assuming, without evidence, that all encounters with that person were the same.

    Did anyone ask if the patient was also a contributor?
    Wouldn’t make as interesting a story, though. Much easier when you can paint one party as the bad guy.

    And how does anyone even know whether the active infection was in fact the one caused by the Hepatitis A? Was this the acute infection or only a serendipitous historical finding in the viral workup?
    I don’t see how the story makes this clear. I don’t assume that the finding was automatically reportable; why do you?

    I see lots of patients, I get along just fine with most of them. But occassionally one comes along that rubs me the wrong way, or is even in my view outright criminal. Some are abusive of practice services and staff. Those are the sorts of patients I want to offer as little encouragement to return as I can. Oh they get professional service, and are well treated as their behavior allows (had to call the police one one drug seeker), but I have to wonder whether they consider me a “difficult” physician.
    So be it.

    I’m with the other poster. If you’re not happy, vote with your feet. And don’t cry if you have bad insurance and find not every door open to you.
    Professional care is a right to expect; having your insurance accepted isn’t.

  • Anonymous

    “physician that didn’t agree with them”

    Are you saying “wouldn’t reveal nature of my blood test, result of test and its meaning, his diagnosis and its prognosis” is DISAGREEMENT?

    If there’s any doubt about the hepatitis infection, whose fault is that? The physicians.

    He was LAZY at best and negligent at the worst.

  • Anonymous

    In context it is very clear she had an active hepatitis infection.

    “The test came back, and he said I have a virus,” Ms. Wong said. “He said, ‘Take this medicine for two weeks.’ I asked, ‘What kind of virus do I have? How did I get it?’ But he just said, ‘Take the medicine and come back in two weeks.’ “

    Two weeks later, she still felt ill. “He said, ‘You’re fine, you’re fine,’ ” Ms. Wong said. “I said, ‘At least tell me the name of the virus.’ ” But, she said, “He just patted my shoulder and sent me out,” telling her to return in three months for another blood test.

    He initiated treatment on the basis of the blood test, and asked for repeat blood work 2 weeks later.
    The only “virus” she tested positive for was Hepatitis A.

    I DO assume it was reportable and there is no excuse for him not explaining to his patient precautions that should have been taken to protect others from infection.

  • Anonymous

    No, there is nothing at all in the story that says which tests for Hepatitis A were positive. The “reporters”–more like storytellers–don’t bother to even clarify this or get the report from the doctor. A finding of a positive hep A IgG but a negative IgM and no elevation in hepatic enzymes, and no icterus, or other findings specific to acute hepatitis A is not a reportable event.

    And the story says nothing about the nature of the treatment. Why do you assume he was treating the virus specifically and not just the symptoms? The story doesn’t say.

    Since the story reports only one side of this transaction, and apparently makes no effort to verify that (1.) the doctor actually behaved as she says he did and (2.) he actually didn’t report a supposedly reportable disease, if in fact there was actually one to report.

    It’s a lousy story. It is written to appeal to readers whose like to be outraged, even in the absence of objective fact gathering that is usually a stantard in better reportage. If you like getting your pants in a bunch, it’s fine, but if you are wanting facts, it falls far short.

    And who was that all so ready to march off and call the Board of Health and the Board of Medicine? Please get yourself a life.

  • SarahW

    This article actually focuses on the shortcomings of “voting with your feet.” Doctors may be unaware of how their communication style (or lack of it) is doing harm or impeding optimal care.

    Isolated incidents are one thing, but “voting with your feet” also does little to protect other people the behaviour will affect – i.e., other patients, or partners or employers of the physician who would really rather know if there is a recurring problem.

    I don’t think it’s so outrageous to want to report the doctor who could not be bothered to explain test, diagnosis, or treatment. Furthermore, I think it was more probably an active hepatitis A infection than not, given the patients account of events. It is certainly more likely than not.

    Yes, it would be lovely to have the patient’s medical records and lab results, but that would have been a diversion from the thrust of the article.

    Assuming it was an active hepatitis A infection, you would presumably have no objection to that kind of behaviour being reported? Don’t you agree that the profession should have higher standards?

    I actually think I would complain to SOMEONE who might do something about the situation, if not the medical board, about any abusive conduct, intimidation (I’m thinking of the teen in the stirrups anecdote), improper care, or failure to conduct an adequate exam or to comply with reasonable requests for information.

    Rating visits of doctors is probably a better idea than counting on patients voting with their feet. Accountability changes behaviour.

  • Anonymous

    “Fix the reimbursement system, and you’ll see these communication problems magically vanish.”

    Oh please. That’s the rankest of nonsense, once again assuming all doctors are Dr Welby. Newsflash: they’re not. It’s why I’m changing doctors, and have to do so stealthily so as not to ‘annoy’ the current one.

    And asking for copies of your test results etc? Grumpy and incomplete response from staff, even when I offer to pay for the copies and ask sweetly. Ridiculous.

  • anon

    report? how? to whom? no one will listen or will get covered up. I care for my elderly parents. Their physican sexually harrassed me and defamed me in the medical records. Reported him to the county med society, the hospitals where he did this to me and have gotten no where. The medcial boards are made up of ….physician! no one cares..lives are meaningless to doctors–patients are just dollar to be made