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The Flip Side--The Rules for Patients

Posted Nov 30 2008 12:20pm
Recently we posted Six Rules for Doctors from Dr. Rob. Well now it is time to post the rules for patients from Dr. Rob. He has a fascinating blog at http://distractible.org/dr-rob/

Getting along: Part 2 - Patient Rules
August 11, 2008

I kind of figured that I would not get much disagreement with my previous post (at least from patients). It is easy for me to criticize my own profession and feel fairly safe, but turning the spotlight on patients makes is riskier.

My purpose in writing these posts is to get both sides looking at things through the other’s perspective. In this post I don’t want to get patients feeling sorry for doctors; I want them to understand how they can either help or harm that relationship.

So here are the Patient Rules:

Rule 1: Your doctor can’t do it alone
The best doctor can do very little with patients who ignore instructions. Sometimes noncompliance is partly due to physicians not explaining things well, but medical compliance is ultimately in the hands of the patient.

I am mystified as to why some patients will ignore nearly everything I say and yet continue coming in for regular appointments. It is frustrating, causing some physicians to get angry with these patients (and even discharge them). I figure it is the patient’s dollar that is being spent, not mine.

Going to the doctor has no therapeutic benefit in and of itself. If you disagree with what is recommended, don’t pretend you agree and then ignore your doctor’s advice. I would much rather have a patient tell me “I am not going to take that medication” than have them accept the prescription and not get it filled. Your doctor prescribes them for you, not for him/herself.

Rule 2: Be Honest
Nobody likes to look silly. I think the main reason most people are untruthful is that they are embarrassed about the truth. But sometimes symptoms are strange, like the man having a heart attack who described it as “a cold feeling when I take a deep breath.” Sometimes symptoms are embarrassing, like a testicular lump. Sometimes you just don’t want to feel like a wimp, so you downplay your pain.

While I can sympathize with this feeling, I don’t see any good reason to be anything but truthful with your doctor. Yes, your symptom might sound strange. Yes, you may have flubbed up and not followed instructions properly. Yes, you may be afraid of what some of your symptoms may mean. But the goal is to fix (or prevent) problems, and trying to do that with bad information is an exercise in futility.

We physicians hear it all. There are very few things a person can say to me in the exam room that will surprise me. My job is to help people, not judge them as “weird”, “crazy”, “wimpy”, or “panicky.” Don’t worry about making a good impression on your doctor. Just give the facts. That will give the best chance to get the desired outcome.

Rule 3: I don’t play favorites
I have over three thousand patients. I try to do right by all of them. I build relationships over years and even develop quasi-friendships with some patients. But I am professionally obligated to keep emotional distance. Overly liking or disliking a patient will cloud my judgment, and so I try to treat everyone the same.

It drives me (and my staff) crazy when patients come in and demand “special treatment” because “Dr. Rob knows who I am.” It is worse if people try to pretend they are my friends by using my first name. Yes, there are special circumstances where I do see a patient who walks in, but that is dictated by the medical condition, not by how well I know the person.

Doctors I take care of can be the biggest offenders. I try to make it clear from the outset that I will treat them like any other patient and not necessarily give them better access because they are doctors. If I have to give them special access, then something is wrong with the system. Besides, special access for some generally means worse access for others.

Rule 4: Don’t mess with the staff
My staff takes an incredible amount of abuse at the hands of some of my patients. It surprises me what they are willing to say to my nurses and clerical staff but not to me. In general, people see them as an obstruction to being able to see their doctor, and so have little patience for any delay.

There are certainly times that my staff is worthy of criticism, and I expect to hear some complaints. But in general, it is not the individual staff’s fault for things not running well, it is our system that causes problems. We have a system for the entire patient experience in our office, and it works most of the time. There are times, however, when circumstance makes things fall apart. There are also times when the deficiencies of the system are exposed.

My staff has a very demanding job. Remember that you are not their only responsibility - you may be the 100th job for the day. If they don’t meet your expectations, yelling at them won’t fix the problem. Talk to me or my office manager. Better yet, put it in writing so that I have ammunition to change things, because chances are really good that your frustration correlates to a frustration I have.

One of the only reasons patients are discharged from our office is when they abuse my staff. A staff member is generally more valuable to me than a single patient, and I need to show my staff that they are valued by me. It is my job to discipline (or fire) my staff, not my patients’.

Rule 5: If you don’t trust, leave
Trust is the commodity we sell. People go to the doctor because doctors have unique knowledge and experience. The stakes are as high as they can get, so why would you go to someone you don’t trust? I have seen many patients stick with doctors in whom they have lost faith “because I don’t want to hurt his feelings.” That is ridiculous.

When you go to a doctor you don’t trust, you will be suspicious about every bad outcome and won’t even trust when things go well. This is a no-win situation for the physician. It does not matter if everyone else says this is a good doctor; if you don’t trust him, find another doctor.

I have some specialists I trust a lot and send many patients to. Invariably, some people won’t have a good experience - perhaps the doctor had a bad day, was in a bad mood, or the two just didn’t get along. If I hear that mistrust, I always suggest either a second opinion or a change of doctors. None of my colleagues want someone sticking with them if the trust is not there; it is a very high-risk situation from a malpractice standpoint and studies have shown that negative attitudes make bad outcomes much more likely.

Find a doctor you trust.

Please note that trusting a doctor does not mean you should not ask questions. In fact, I think a physician who does not want to be questioned is one you should not trust. Questioning is often the only way to build trust. Unanswered questions tend to undermine trust.

Rule 6: No news might be bad news
“No news is good news” can be a fatal assumption. Never assume that your doctor will call you if there is a problem. I get 50-60 new documents (labs, x-rays, consults, hospital notes) every day. I order hundreds of tests every week. I just cannot keep track of them all. Some will get sent to the wrong doctor and some results never get sent at all. Despite our best efforts to develop a system that will close this loop, there are some documents I just don’t get.

A doctor’s office is always on the brink of chaos - with an incredible amount of information coming in and going out, a large number of phone calls, insurance company headaches, and personnel situations that can throw the best system flat on its face. People forget that there are hundreds of other patients with thousands of test results the office is dealing with. We do what we can to tell patients test results (and with our computerized records, we do a better job than most), and I see that as our responsibility.

If you don’t get your test results, call.



One more point: we aren’t that much different from you. We have good days and bad days. My staff cry sometimes when they are mistreated by patients. I get discouraged and emotionally drained. It really helps to hear thanks. I don’t expect it all the time, but when I do get a card or a nice phone call saying I am appreciated, it can really help.

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It can happen. Doctors and patients can get along. Like any relationship, it takes effort and give-and-take on both sides. The benefits of such a relationship are very satisfying and truly life-changing.
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