Doctors and patients: An inability to talk to one another as people


Dear medical professionals:

We need to talk. I know I walk into your office fearing the worst of you, and I suspect that you may have some hesitation about some of your patients. (Need I say, “frequent flyers?”)

We both have baggage. You have your patient horror stories. I — as a female patient with fibromyalgia and mental health issues — have mine.

My mom is a nurse, so I’ve grown up with her stories: Coming home late because she had to explain ten times that there is no “Ebola vaccine.” The patients who came in 30 minutes late, meaning she sees them instead of eating lunch. I know that insurance companies are horrible to deal with on your end, too.

Here are some of mine: the NP who asked how I “became a lesbian” while she was giving me a pelvic exam. The ER nurses who couldn’t start an IV, and joked that I was “freak of nature” because of my small veins. The gynecologist who told me “women are just crampy” when I told her I couldn’t move the first two days of my period. The ER doctor who asked if I “took a handful of lithium for fun” when I was told to get tested for symptoms of lithium toxicity.

I fear that you will miss a treatable condition (again). It took fifteen years for me to get a referral for premenstrual dysphoric disorder, and now I no longer have monthly bouts of depression.

To begin my soapbox on patriarchy and medicine, say the word “hysteria.”

Surprisingly to some, it’s usually not the procedures themselves that are so bad. I’ve had an EMG, which I’ve heard touted as one of the worst medical tests. Certainly spending an hour with someone poking needles into your arms and legs seems like a CIA torture program. The pain didn’t linger the way your words sometimes do.

What I dread is the unresolved anger; you probably have some, too. My therapist has heard a lot about it. However, there’s really no good way for us to resolve our conflict together.

As a patient, I seem to have four options: 1) smile and nod while promising myself that if we just get through this I never have to see you again; 2) try to address it as politely as possible, which I fear may interfere with my treatment (will you advocate on my behalf if you had a negative impression of me?); 3) avoid going to the doctor until it’s life-threatening; 4) address the issue on my faceless customer satisfaction survey. (I’ve heard some people use Yelp.)

Recently, I read an op-ed in the Washington Post which initially infuriated me. The author, Dr. Sarah Poggi, stated that she was frustrated with the mixed messages she received from hospital administrators about patients. On the one hand, she is warned to watch out for angry behavior and report it to security. On the other hand, “My hospital has made it clear that some of the federal funding we receive is tied to the proportion of ‘always’ answers [on patient satisfaction surveys]; we get no credit for ‘usually,’ which might as well be ‘never’ … In this setting, how are we to treat the rude, even threatening patient? We are tired of the concept that ‘the customer is always right’ when a patient displays a ‘behavior of concern.’ And to be honest, we are also a little afraid.”

When I first read her article, I was angry. “She’s afraid? I’m afraid every time I go to a doctor!” I thought. Then I realized that, perhaps, we are not so different after all.

It seems as though doctors and patients are forced into one of two roles by our inability to talk to one another as people, as well as a hefty fear of litigation. Either doctors are omnipotent gods who hold the power of life and death and must never be questioned, or else they’re the customer service peon who must cater to an entitled individual’s every whim for fear of negative feedback. Similarly, patients are either omnipotent consumers who hold the power of a doctor’s career in the tap of a touchscreen, or humble petitioners to a feudal lord’s court asking for the benevolence of their care. There seems no in-between in which you or I can say that, actually, that comment was inappropriate, discuss it, and then move on with the exam in the fifteen minutes allotted us.

How to resolve this, then, if it’s so hard to address conflict in the exam room itself? I know that my decades of anger certainly don’t improve my ability to get treatment, and may impede my ability to seek timely treatment in an emergency. On your part, a preconceived prejudice may lead to misdiagnosis, a lawsuit, or even a patient’s death. You may decide it’s all too much, burn out, and leave medicine altogether.

I don’t have any pat answers or programs to recommend. For medicine to actually be effective, though, we need a way to talk about both our differences and our similarities.

Liz Moore is a patient and can be reached on Twitter @untonuggan.

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