Why are patients mad at their doctors? In comments on my previous post, people expressed real frustration and distrust - mainly from a lack of listening and connection. Those who loved their doctors (and there were some) expressed the opposite. They had a relationship with their doctor. Here the rules I have for getting along with my patients:
Rule 1: They don't want to be at your office
Not so with most patients. The spotlight is on them and their health. They stand on the scale, undress, tell intimate things about their lives, confess errors, are poked, prodded, shot with needles, lectured at, and then billed for the whole thing. Yes, it seems that some patients are happy to be there - and I do my best to make my patients feel comfortable, but there is always an underlying fear and self-consciousness that pervades when a person is sitting on the exam table.
The best thing to do in response to that is to show compassion. If you feel awkward, scared, or self-conscious, the thing you most want is for someone else to understand how you feel. Patients are much more likely to follow a doctor's advice when the feel that the doctor understands. Identifying the fear and relating to it are the first steps at building trust.
Rule 2: They have a reason to be at your office
People don't like to waste time and money. They don't come to the office to waste the doctor's time. Yet early in my training I was incredulous at the reasons some of my patients were coming to see the doctor. Why come in for a headache? Why come in for a cold? Doesn't the person realize that a stomach bug won't get any better by coming to the doctor?
It took me being in my own practice (and trying to keep my business going) to realize that there is (almost) always an underlying reason for a patient to come in. Sometimes that reason is simple: they need an excuse from work, or they have terrible pain that needs to be treated. Other times, however, the reason is more subtle. When a person comes to my office with enlarged lymph nodes, for example, the real reason they are coming in is that they are afraid it is cancer. When patients have chest pain, they are afraid it is their heart.
On every visit I try to identify the real reason (or the real fear) that brings them to see me. I don't end the visit until I have addressed that reason. If they have an enlarged lymph node, I make sure and say "I don't think this is cancer because...." If they come in with chest pain, I say "This doesn't sound like a heart attack because....." If I fail to do so, then they leave the office with the fear and feel ignored.
Rule 3: They feel what they feel
Patients will often tell me their symptoms in a very apologetic tone. They seem to think that they have to come to me with the "right" set of symptoms, and not having those symptoms is their fault. Sometimes those symptoms make no sense to me at all and I am tempted to dismiss or ignore them.
But as a physician, you have to trust your patient. Only the really crazy patients make up symptoms. Yes, some may exaggerate what they feel out of anxiety or out of fear that you won't hear them for lesser symptoms, but then your job is to uncover the anxiety, not ignore the complaint. I have heard from many patients that their doctor "did not believe" their complaints because they did not make sense. If you don't trust them, why should they trust you?
If symptoms seem contradict what I know to be possible, I often openly tell them that this seems to contradict - but I make sure I don't imply that they might not be being truthful. A puzzle is a puzzle. It is my job to undo a seeming contradiction. I may not ever be able to do so, but at least I don't make them feel bad for feeling what they feel.
Rule 4: They don't want to look stupid
I remember when I broke my shoulder - a compression fracture of the neck of the humerus bone - and went to the orthopedist office. I always felt self-conscious about how much pain I was reporting. A colleague had fractured his humerus the year before and had reported he was back to doing surgery within a few weeks. Here I was, a few months out and couldn't even lay down in bed. I felt like a wimp. Was this other guy just tougher than me? My orthopedist made me feel much better when he explained that my colleague had a mid-shaft fracture, while mine was right in the shoulder joint - a much slower place to heal.
This event made me realize how many patients felt when they came into my office. People are often worried that they are over-reacting. They wonder what I must think for a person to come to the office with that symptom. This is especially true of parents bringing their children in. Nobody wants to be "that mother that over-reacts to everything." In response to this, I try to specifically say, "I am glad you came to the office for this because..." or "Yeah, I can see how that worried you because it could be...."
Rule 5: They pay for a plan
What do people pay for when they come to the medical office? They pay for opinion, yes. They pay for knowledge as well. But what they really pay for is a plan of action based on their circumstance. If they have an ear infection the plan is to use antibiotic (maybe) and treat the pain. If they have abdominal pain, the plan may be much more complex. They want to know what is going to be done and want what is done to help.
I try and give a plan, either verbal or written, to each patient that walks out of the exam room. What medications are given and why? What medications are to be stopped? What tests are ordered and what will the results mean? When is the next appointment? What should they call for if they have problems? The better I can answer these questions, the more confidently the patient will walk out of the exam room. The days of paternalistic medicine are over - no handing a prescription and just saying "take it." Patients should know why they are putting things in their body.
Rule 6: The visit is about them
With all of the stresses in a doctor's office, I get tempted to complain about things. Who better to complain to than someone who feels much the same way? But patients are paying for you to take care of their problems, not the reverse. I keep my personal gripes or frustrations to myself as much as possible.