Assumptions in medicine can inhibit care

Assumptions are ubiquitous. Neither patients nor physicians are exempt. Sometimes they are justified, other times entirely misguided.

Webster’s defines “assume” as “to take as granted or true.” The cliché’s have probably always existed: Doctors are greedy and paid too much, and are uncaring. Some patients believe doctors do care and that their doctor actually likes them. That’s an assumption too. Some assumptions are newer. Patients assume doctors will substitute their prescription for one on the $4 list and when that doesn’t happen they become angry. Some patients become enraged when they have to wait for the doctor. What do they assume the doctor is doing while they wait, writing a blog?

A common assumption I have noticed is that people assume I will see them. “Hey doc, I need to make an appointment with you.” It’s a mistake to assume I am accepting new patients. I guess this is a justified assumption, because I am young and I have historically taken all comers. But I did this to the detriment of my own health and my family’s well being so I have slowed down. My community, like many others, doesn’t have enough physicians to support the growing number of patients calling for appointments. People still assume they will receive medical care. I assume they will too. If they are not already my patient, it will be somewhere other than my office, and that is not an assumption.

I have read blogs where patients state “doctors think they are smarter than the average person.” Is that an assumption or is it true? Isn’t that a fact supported by evidence? Isn’t being smarter than average a requirement to becoming a doctor, of any profession?

I have been guilty of assuming that patients want me to treat them to the standard of care. I have offended several patients with this assumption. I suggested they take medicine for their high blood pressure rather than continue spending years attributing it to “white coat syndrome,” or to make a follow up appointment to monitor their uncontrolled diabetes.

One man responded to these suggestions stating, “I am a customer first, a patient second,” assuming that was ok with me. I felt it was in his best interest to find another physician. He agreed, so I assume he did.

A common assumption doctors make is that they will continue to be able to make a living. The cash flow problems resulting from the recurrent “doc fix” debacle in Congress has not stymied that assumption. Most doctors I know studied medicine to practice the art, not run a business. Many hear about health care changes but assume it will all work out. None of us should assume things will get better. We should prepare for things to get worse. Patients and doctors should be careful with their assumptions, we are better off when we approach each other without them.

Patrick W. Hisel is a family physician.

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