How patients can stop doctors from blaming them for their health

If doctors need to listen to patients to figure out what’s going on, patients need to tell doctors what’s going on.  Why is that so hard sometimes?  It’s hard to speak up when you feel rushed, but have doctors ever done other things that made it harder for me to talk to them?

Sometimes doctors blame the patient

Years ago I got a terrible abdominal pain.  I could only explain that it felt like the stitch you get in your side sometimes when running.  Since I hadn’t been running, and it continued for days, I finally called my family doctor.  Unfortunately, she didn’t have any openings in her schedule so one of the other docs in the practice saw me.  Another symptom – very weird, and not one I exactly wanted to announce - was that the pain got worse when I used the bathroom.

The doctor learned this only based on questions that he asked (I certainly didn’t volunteer the information), then this obnoxious person told me that perhaps it hurt because I expected it to hurt.  I didn’t say anything else; I was done talking to someone who seemed to simultaneously dismiss a fairly painful and embarrassing problem, and blame me for my symptoms.  I’d been using the bathroom just fine for 24 years; why on earth would I suddenly start thinking it would hurt?   My expectation was that I would not live in pain.  When that doctor then asked if I’d be comfortable with him doing a pelvic exam, I told him no.  Another doctor, who made time to see me, discovered a grapefruit-sized ovarian cyst.

Experiences like this color future interactions with other doctors.  Don’t say anything that might be interpreted as something for which the patient could be blamed.  When a doctor wrongly suggests,  “It’s your fault that you feel this way,” that’s a sure-fire way to guarantee that I’ll clam up.

I can only think of one other time that I was blamed for a medical situation.  Tramadol was prescribed.  In the first place, I didn’t want to mask symptoms with pain killer; I wanted to solve the problem so that the pain killer wouldn’t be needed.  However, I was desperate so agreed to take the tramadol.  The instructions I was given said take 100mg up to four times a day.  Within minutes of taking my first (and only) dose, I felt horrible: the room started spinning, my speech was slurred, and I was extremely nauseated.  Then I began vomiting.  It was so awful that I couldn’t eat anything for the next three days.

The prescriber’s response was to blame me: “It looks like you’re medication sensitive.” By that time I’d done a little research – including a long conversation with my PCP.  This was not a case of being overly sensitive to the medication.  This particular medicine had to be titrated up to that dose.

Although it would be easy to go on and on in a rant against that particular prescriber, I’ll refrain.  The point is that he blamed me.  He’d made up his mind and was stuck on a specific treatment track without being open to my input.  In response, I was no longer willing to talk to him.  Sure, I showed up for follow-up appointments, but I didn’t volunteer any information that he didn’t specifically ask for.  I was done talking to him, and hated having to see someone like him.

What’s a patient to do?

If we can’t talk to our doctors, they can’t help us.  At least not effectively.  Like a harmful cancer, silence between doctor and patient needs to be eradicated.

In the spirit of not pointing the finger at others, the most obvious solution to the blame game is to avoid being at fault.  For instance, if I don’t want to be blamed for being non-compliant, then I shouldn’t be non-compliant.

Sometimes faultlessness isn’t sufficient.  As my two examples show, sometimes the patient gets blamed anyway.  I think there are two possible solutions when this happens.  The first is to address it directly.  Without being overly confrontational, it’s possible to say that it seems like you’re being blamed for something unjustly and would like to know why and if there’s any way to fix the problem.  It might be a simple misunderstanding; you’ll come out of it with a better relationship with your doctor, knowing that you can speak up and will be heard.  The other option is to find a different doctor who won’t place blame when it’s undeserved.  I’m not a big fan of doctor-shopping, but on rare occasions it might be needed.

There is one other situation, though.  Sometimes we might be blamed for problems in our health because we are to blame.  What a concept!  Personal responsibility.  Instead of getting offended and refusing to talk to the doctor, hard as it might be, wouldn’t it be better in the long run to admit it when we screw up and ask for help fixing the problem?

  • Do your best to not be at fault
  • If you are at fault, admit it and move forward
  • If you’re unjustly blamed, address it

Let’s respectfully speak up instead of letting blame create even more silence.

WarmSocks blogs at ∞ itis.

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  • ItIsAName

    Since you took an acceptable starting dose of tramadol and never took a 2nd dose it doesn’t really matter if the prescribed amount was too much. You never took it. You took 1 pill of an acceptable starting dose.
    So it would appear that you had a bad reaction to a typical accetable starting dose of a medication. The doctor’s response was that apparently you were sensitive to it.
    That seems to be a rather accurate and obvious statement. Now I don’t know if this was the same doctor as the ovarian cyst one. But if this was a first time perceived slight than maybe you could give him the benefit of the doubt and think that maybe a completely innocent accurate statement was not meant as an attack on your character.
    YMMV.

    • http://warmsocks.wordpress.com/2010/05/03/more-on-speaking-up/ WarmSocks

      An acceptable starting dose is 25mg once a day; I was told to take sixteen times that amount: 100mg four times a day. Huge difference. I took one dose of two pills as prescribed, when I should have been instructed to start with half a pill. The specialist who did the prescribing screwed up (per my PCP).

      This is part of a series of post pondering why it is sometimes hard for patients to speak up at the doctor’s office. If the doctor blames the patient, the patient is not going to voluntarily ask to be blamed again.

  • http://www.eatingdisorderrecovery.com Joanna Poppink, MFT

    Dear WarmSocks,

    You raise important issues in your article. My hunch is that being blamed for personal medical issues may be kept secret because many patients may experience shame at the accusation.

    They may feel shame because their doctor is demonstrating a lack of respect. The patient may not believe the blame is warranted, but if self esteem is low, they may believe they deserve to be treated with disrespect.

    That can create a total shut down in communication where the patient becomes passive, dull and accepting of what the doctor says. The patient agrees and no longer offers any information. This communication breakdown makes treatment more difficult. The doctor needs information to be effective.

    Yes, I agree with you about discussing such problems with the doctor when they arise. However, if the problem is not corrected amicably in moments, it’s my opinion that the patient has a better chance of getting quality treatment from a different practitioner.

    If a person knows she has self esteem issues and finds it difficult to stand up for herself when someone in authority treats her badly, she can ask a friend to accompany her to her appointment. Having a witness present may help her speak up and may keep her doctor civil and respectful.

    You raise excellent points, WarmSocks. I hope people who need this information find your post.

    Joanna Poppink, MFT
    Los Angeles psychotherapist
    author: Healing Your Hungry Heart

  • http://brucesmallsurveys.typepad.com/ Bruce Small

    You stopped talking to your doctor, and you wonder at poor outcomes?

  • Wrench

    At our medical staff meeting we were discussing patients readmitted within 30 days and the fact that in the future, Medicare would not reimburse for those admissions. Most physicians felt that this was because patients were noncompliant, especially heart failure patients which have a particularly high boune back rate when their ejection fractions are low. I offered another explanation. Perhaps people with very sick hearts bounce back frequently despite physician’s and patient’s best efforts. When things go awry and patients get worse or the physician does not understand what is going on, typically they blame the patient either for noncompliance or for having supratentorial problems. I am not denying the existence of psychosomatic illness or noncompliance. What I am saying is this should not be the “go to” mode for physicians. Furthermore, there is a reason for everything. Try to get at it.

    There are also patients who get treated poorly because they “deserve it.”. The fat patient with hypertension or back pain for example. The smoker with COPD or lung cancer. The prostitute with AIDS. But does anyone “deserve” to get sick. Every patient deserves our compassion and our best efforts at easing their suffering.

    Excuse the misspellings I typed this from an iPad.

  • Matt S

    “Sure, I showed up for follow-up appointments, but I didn’t volunteer any information that he didn’t specifically ask for. I was done talking to him, and hated having to see someone like him.”

    …that’s an awfully counterproductive strategy. It sounds like “I didn’t like my teacher so even though I kept going to class, I didn’t pay attention or do any of the homework. I ended up failing the class. That’ll teach her.”

    • http://warmsocks.wordpress.com/2010/05/03/more-on-speaking-up/ WarmSocks

      Matt, I didn’t say I didn’t pay attention or do what was suggested. I kept follow-up appointments, I took my prescriptions, I answered any questions that were asked. I just didn’t volunteer extra information.

      If doctors want patients to talk, they might be interested in knowing some of the things that hinder open communication. I provided a couple examples. If someone blames me for things that aren’t my fault, I’m not going to be enthusiastic about giving them new opportunities to do it again.

      FWIW, I eventually persuaded my PCP to do the follow-up so that I wouldn’t have to keep seeing that particular specialist.

  • HJ

    I notice that there is more blame for WarmSocks but where is the criticism for the doctor who puts the “it’s all in your head” at the top of his differential diagnosis for abdominal pain.

    Is it a prerequisite for patients to not show any emotion to get the appropriate health care? What about those of us that are scared, embarrased, depressed, anxious, etc…?

  • jsmith

    Blaming pts when things go bad or when we don’t really know what’s wrong with them has a long and inglorious history in medicine. Schizophrenic kid, blame mom’s poor mothering skills. Can’t find the cause of the pain, say it’s all in your head. It goes on and on. I’m sorry we do this sometimes. I don’t expect it will go away.
    We’re not the only ones who do it. Just now the nurse came in and commented to me about our “difficult” pt. He’s not difficult, just sick.

  • Anon EM doc

    Before I write “pt is a questionable historian” in my chart, I try to ask myself whether I have been a questionable history-taker. Oh, and whatever doc wouldn’t suspect ovarian cysts is the one with supratentorial issues, not you. That said, the analogy about a student failing a class for revenge on their teacher was spot-on. When will people (doctors and patients alike) start accepting responsibility for their own actions or lack thereof??

  • stephanie

    Doctors shouldn’t blame patients or their health. Sure some of the patients may have neglected their health and all but that doesn’t give doctors the right to scold them. Doctors should maintain a therapeutic relationship with their patients.

  • Annie Stith

    It’s difficult for me to not go absolutely flaming when this topic comes up. (And, no, I don’t believe that’s my fault, either.)

    I have had Fibromyalgia since it was called fibritis, and long before any acceptance as a legitimate Dx of anything more than a “trailer trash Dx.” It took years before the Dx, during which I got a lot of “it’s all in your head” and “you’re exaggerating.” Meanwhile, the habit of writing off pain complaints missed my developing OA and degenerating disks.

    I was also one blamed for joint pain because I was overweight, and blamed for being overweight. (I’d already had problems with fatigue being discounted.) I even had a doctor tell me I had to be lying about my diet. What got written off as insignificant was my family’s history of obese women. What got overlooked was hypothyroidism.

    Have your doubts — fine. Don’t solidify them without checking things out, allowing our health to continue to deteriorate due to legitimate medical problems.

    In return, I won’t make assumptions about bad doctors without first making certain I completely did my best as a patient.

    Annie

  • Michael F. Mirochna, MD

    It’s ironic that in a post about being blamed for her health, she again gets blamed.

    On another note, missing OA isn’t a big deal because there’s nothing to do to prevent it (that I’m aware). The data on glucosamine chondroitin isn’t terrific.

  • Annie Stith

    There may not be “prevention” for OA, but there is appropriate treatment for the relief of pain, i.e., PT, anti-inflamm, muscle relaxers for tension of supportive tissues, etc. It’s not always about prevention. (And there is prevention of continued abuse to the joint thru education about proper posture, gait, etc., thus slowing the progression.)

    In the same light, G/C with HLA also provides relief for me, personally.

    Annie

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