| July 6, 2007
. . . or pain in the ass? There is a fine line.
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The patient might be intimately familiar with how their condition affects them, but they might know squat about thier condition. At best, the patient has an N=1; not always better than the medical student and often bested by the intern’s experience.
The wise patient wants to learn from others experiences. What can go wrong, what can work, what are the biggest mistakes, are all issues that have likely been dealt with by someone else in their physician’s experience. It is the height of folly for the patient to insist on calling all the shots only to have to suffer all of the lessons that the doc has already learned with the prior patients cared for.
Having a background as a librarian, any doctor who doesn’t expect me to come in armed with information – highlighted with a question of what does he or she know about this new fangled treatment for my condition, is just foolish. (Occupational hazard for librarians.)
Of course, being a librarian, if I’m bringing a printout of anything but my history – for my own reference – and my list of questions, it is going to be a literature survey I found that may or may not be relevant to my particular case. I expect the physician to know whether that is relevant to me and that is why I am bringing the information to him or her. I always take the trouble of highlighting the relevant section!
Of course, there is always new information because I am not the medical expert I need the physician to clarify if it is relevant. I am the patient and want to learn as much as possible about my condition so I can manage it more effectively on a day to day basis. So, if in one of the support groups I am on online says they tried X drug or therapy, and had this benefit, I will ask if that is relevant for me if I am suffering similar treatments.
Of course, there are consults where the patient is going to have many more questions than other consults. Sometimes the first consult is an overview of a new diagnosis. Unfortunately, our system of medicine does not seem to understand that if you give a certain subclass of patients about a week to 2 weeks to digest information, a follow-up with a more focused information sharing session should probably be scheduled. This tends to be lacking in our present day system.
Also, don’t underestimate the power of the “sudden surprise” diagnosis to derail patients who are otherwise quite focused. I’ve been there, nothing like getting a new issue introduced into an already complicated medical history.
My question is, sure, the average patient isn’t going to need that kind of focus, but there is a significant population that should probably be scheduled when you have some wiggle room with your schedule – or at least offered a double-booking?
But, I admit, I seem to be in a small minority of folks who consider medical treatment yet another consumer good with much larger ramifications.
I don’t think it is that fine of a line, lol. I know lots of patients who are a major pain in the ass. I’m know I have been one of them in the past.
So how about doctors letting patients know what their expectations are up front? Some look at you like you’re a dork if you don’t ask questions and talk it up; others are quick to interrupt if you say more than three one-syllable words in a row. I’m happy to be whatever kind of patient ya want…just give a clue, OK?
The one thing patients get off the internet is too much information. A patient typically says “Oh my pain could be a side effect of Pepcid” or “Could my muscle aches be from thyroid disease?”… when in reality they lack ANY sense of what is expected in these conditions. They pick out one thing in a long exhaustive list, but they haven’t a clue what is common or what it looks like.
So then as a doctor, I just get frustrated being asked not only to diagnose, but to explain away all the internet clutter. THATS what being a pain in the a** patient means.
I have built my practice on empowered self-responsible patients because those are the kind of people that I like to deal with and dependent helpless people give me hives.
There is definetly a line. If you want to bring in lots of literature and have me talk about it, I will do that and schedule a visit to do so if I need to in order to still have time to do my assessment and treatment and respect other people’s right to be seen on time. Expect to pay for the time.
I will not spend my time explaining all the fallacious internet claims that you can possibly find. I don’t have that much time or patience and you do not have that much money. If you bring something, bring something credible.
My explainations are going to be of the sort appropriate for doctor-patient conversations. I am not goiing to take on the futile task of giving you a five minute med school course and could never teach you all that I know. I am pretty good at cutting to the gist, so that usually isn’t a problem, but some always want more.
If you fall outside the realm of what I call empowered and into what I find the pain in the ass range, I will get you to find another doctor. I have a right to pursue happiness just as much as you do. It doesn’t make you a bad person or me a bad doctor–it just makes us a poor fit for each other.
Anon 8:55, excuse me for being a pain in your ass right now, but what is it again that you just said? Because I keep reading it and it seems as though you are contradicting yourself. Are you saying you want empowered patients because you don’t care for dependent one’s, But, at the same time, they MUST ONLY be as empowered, as what you will tolerate?
When the day comes that I have to walk that fine of a line at my Drs., then I’m apt to think you may well be a pain in my ass, and willingly seek a new Doctor…..:)
“I will get you to find another doctor. I have a right to pursue happiness just as much as you do. It doesn’t make you a bad person or me a bad doctor–it just makes us a poor fit for each other.”
If you make this decision and it affects ONLY this one doctor-patient relationship, then I’d support your approach. However, in physician groups, if one doctor terminates his/her relationship with the patient, then the patient loses access to all other doctors in that physician group. Thus, you have assumed you have the right to make the final decision about numerous other potential doctor-patient relationships that might well have worked just fine.
In every service-based occupation, we ALL have to put up with some people we just plain don’t like very much. You can be an ass, decide that you are the only one that matters, and make decisions whose permanent consequences are far worse than the temporary inconvenience that triggered them; or you can accept that your judgments in the brief time that you spend with your problem patient could easily be very incorrect, inhale deeply, grit your teeth and get the job done.
That is a good outcome, a mutual agreement that it isn’t a good fit, simultaneously reaching that understanding. My life, my blood pressure, my wife’s evenings, all became much better when I realized that I don’t have to be everyone’s doctor, and everyone doesn’t have to be my patient, and no harm results from that. There are thousands of doctors in this town. The realization came with a prolonged unexpected medical leave from the practice showed me that my patients could find care and do fine without me, and that when even a large portion of the practice melts away, it is replaced by others who choose my services.
We are all just trying to get through this thing called life and I make my living helping ease the way of handful of folks. I am a folk too and, as long as I am honest and cheat no one, have the right and necessity to ease mine as well.
I understand and accept that most people, when suffering are a pain in the ass sometimes. I know I am. Some people on the otherhand feel special and feel entitled to more than what is their due, more than they pay for, and without regard to the impact on everyone else who has an appointment.
When I was in a group, I took a lot of people that I wouldn’t take in private practice to support the group. I am a team player and not a user or sociopath and pull my weight. The beauty of private practice is that I don’t have to do that.
Regarding griting my teeth, it was while in the group that I did that literally, wore the enamel off my teeth, and required extensive restoration. Been there, done that. I now realize that under this white coat is a human being who, if chooses, has a right to be happy and enjoy his work.
The difficult patients of the world are not going to have any trouble getting a doctor because of my decision, they will just end up with the more stress tolerant ones (God Bless Them), or the martyrs who are killing themselves throwing themselves on the flames everyday.
It is easy to see why freedom is so rare in human history since people are so offended by people simply autonomously minding their own business and choosing with whom they associate.
re: “Expect to pay for the time….”
Now that is friggen hilarious. I can’t remember the last time a patient was willing to pay more than their copay for my time. That would be one 10-20$ copay no matter how much time I spent with them. On top of that, read the internet section from the article and she states faxing internet info a “week ahead of time” so “we can discuss it”. Tell me docs what would happen if this ocurred on a daily basis (which of course we will not be reimbursed for). For every good site on the internet on a health related area I find 5 garbage sites.
For all you “I hate the way we’re paid” physicians who also don’t like the thought of empowered patients, wait until they’re paying for it out of their pocket.
Some of you had better pray for the status quo or single payer.
When I see my specialist, because I truly am special *a little HUMOR there*
I do, indeed, pay for his time. He bills hourly and pro-rates his visits for the time he spends with you. I have no problem with that and am happy to pay out of pocket & then I file the super bill with my insurance company.
Reading comments on blogs like this sometimes gives me the impression that all doctors hate all their patients. In which case, maybe some of you should find different professions.
Who asked you anyways megan
“For all you “I hate the way we’re paid” physicians who also don’t like the thought of empowered patients, wait until they’re paying for it out of their pocket.”
Guess I will be waiting until hell freezes over, because that will happen before pt’s pay docs out of pocket on a regular basis.
“who asked you anyways megan”
anon 10:45 pm: are you as arrogant with your patients as you are with posters on this thread?
I can assure you that no private patients will ever be in your stable if treated with the same smart ass quips you dole out here….well, maybe if hell freezes over.
You came to a medical website frequented by physicians who are much freer to express here their frustrations with their work than they would in their encounters with patients, and then you post your disapproval.
If you don’t like the subject, browse elsewhere. The simple fact is patient care can be very frustrating at times. That is life.And it is also the right of those who want to to express themselves as long as our host approves.
This site was not created to reinforce your illusions about medicine.
Why not accept the fact that many doctors have at least a few patients they dislike and would prefer not to see? That might require you shedding unrealistic notions you may have about doctors, that while specially trained, they are people with likes and dislikes like most people. Being a professional does not require limitless tolerance of unpleasant people and does not require one to be a martyr to the unreasonable.
Saying that you think that those doctors who post here must “hate” their patients makes you look like someone with a borderline personality trait.
I can appreciate what the ex-librarian said.
That said, I understand quite well the difficulty of being a patient (that’d be me)in that so often, there is too little time spent in the exam room. I think in the long run, this can and has often posed problems for both physician and patient.
One thing that comes to mind, that I think would be helpful for both, is to have a “go between.” Meaning, a qualified person (perhaps a R.N.?) who’s primary job is to answer questions. He/she would not be there to exam or diagnose in any way, simply help the patient with their questions. Perhaps in this, it would reduce the amount of questions (and time) in the exam room, as well as any “anxieties” that come with questions left unanswered. Just to name a few good reasons.
As a patient, this is something I would be willing to pay up front and out-of-pocket.
All one has to do is venture over to medhelp.org in the paid Q&A forums to see this.
Borderline? That’s laughable.
Trust me, I don’t have any illusions about medicine. I’ve seen enough of health care to be long past that.
I like the subject just fine, I just don’t like some of the responses to the question.
The original post was talking about patients being a pita by bringing pages and pages of print outs, then doctors here complain that people ask questions at all? God forbid.
And I’m fine with you having patients you don’t like. Trust me, I’ve had plenty of those myself, it’s the generalizations here some people are making that bother me about their patients in general.
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