For her article on Doctor/Patient relationships Tara Parker-Pope, she asked me if I had any negative experience with patients and what I thought about the current state of this relationship.  I wrote down my thoughts for her (and a quote did appear in the article) and she later suggested it may be a good blog post. Good idea.  I already did the work.  So here it is:

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Tara:

I had one case where someone said they were “going to break my head open with a baseball bat.”  It was for something very minor – I had seen this guy’s daughter and diagnosed them with an upper respiratory infection and a few days later they were diagnosed with “bronchitis” and given an antibiotic.  This is the only case that I recall where they got specifically mad at me.  We called the police.  We also dismissed the family from the practice (of course).  I strongly suspect that the guy had major emotional/psychological problems to begin with.

In general, patients are far more likely to get mad at the staff than at the doctors.  I have had patients use profane language to my staff and say that they are going to tell me off when they saw me, only to have them be meek and quiet in the exam room.  We have a rule, however, that abusing our staff in any way is a reason for dismissing a patient from the practice.

The most likely patients to get angry and frustrated are those who don’t come in very often.  They don’t have much of a relationship with me or my staff, and so they don’t give us the benefit of the doubt when it comes to us running late or mixing things up.  They are far more likely to just walk out without being seen.

I have noticed that patients are far more likely to question medical decisions than before.  I think the information on the Internet has been a cause of this.  Doctors used to be the only source for information on medical problems and what to do, but now our knowledge is de-mystified.  We are not as valued for what we know.  So when patients come in with pre-conceived ideas about what we should do, they do get perturbed at us for “not listening.”  I do my best to explain why I do what I do, but some people are not satisfied until we do what they want.

I wonder if the trust that doctors have of their patients is also eroded.  We are far more defensive in how we do things and much less likely to admit when we don’t know things.  When doctors are afraid of being sued for any small mistake, they are more guarded in what they tell patients and I think the patients sense it.  This is not as much the case in primary care, as I have an ongoing relationship with the majority of my patients, but it does take its toll.

I suspect the payment system has something to do with it.  When patients don’t know what we charge for things (we are not allowed to disclose our fee schedules), they assume we are milking the system for all it’s worth.  The fact that the majority of transaction happens below the surface devalues the visit.  I think this is why many physicians' experience is that the Medicaid population (which doesn’t pay at all) is the most demanding, while the self-pay seem to be the least.  When you buy something at the store, there is an expectation of higher quality for higher cost.  This holds the seller accountable for offering enough value for what they sell.  When patients pay a small co-pay (or none at all), there is no financial accountability.

Still, I wonder if there really is an “epidemic of anger” towards doctors.  Yes, there are stories of patients attacking doctors, but this may be more a fact that information flows freer than it ever did.  It is kind of like how parents are all paranoid about letting their kids play in their yard because they may get abducted by a stranger.  The risk is far less than most parents think.  Overall, I have had very few negative interactions with my patients.

I hope this helps.

Rob

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There is an interesting video on the blog.

Thoughts?

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