A question that has received a lot of attention in the doctor community is whether patient attitude affects the quality of care they receive. In an effort to tackle it, let’s take a look at two of my past patients.
Case Study #1: No matter how late I was to see him, or how bad the news was when I did see him, Mr. X was unflaggingly polite. He had a quiet, gentle voice, and his “Yes, doctor” and “Thank you, doctor” responses were kind and reassuring. He is the only patient who ever thanked me for offering him dialysis. He chose home dialysis, learning the mechanics of the system quickly and managing the multiple medications we prescribed without any problems.
Case Study #2: Mr. Z usually paced my tiny exam room like a tiger in a cage, and I felt like the unlucky keeper. “Why the hell can’t you fix my kidneys?” he would shout. “What kind of crap is this?” During one visit, I remember wishing I’d put myself nearer to the door. “I’m sorry, sir, but we don’t have any medicine to reverse kidney failure,” I would try saying. “I know,” I told him, “it’s a horrible thing.” His responses were often a string of expletives. I would offer him follow-up visits and escape from the room.
So who gets better care?
I worry about this quite a bit. From what I see, Mr. X (and patients like him) get better care and do better overall, in part because they take their medicines, come to appointments, and understand that we are working together.
Mr. Z doesn’t do as well—partially because he does not take his medicines and sometimes doesn’t come to follow-up appointments, but also because of his interactions with doctors.
This is not to say that Mr. Z’s doctors are deliberately holding back good treatment. At least, I’m not. But maybe our visits are shorter. Maybe I don’t spend as much time examining him. Or maybe I don’t (or can’t) engage him in the “small talk” that gets a visit rolling, so we don’t establish a relationship in which he would feel more comfortable sharing critical details.
Research suggests that people with personality disorders or psychiatric issues are less satisfied with their medical care. This could be because the care isn’t as good.
You might say that this is an inescapable unfairness; if people can’t engage and participate in their medical care, then of course they aren’t going to get good care. I accept that to some extent. I can’t force people to do what I think is right for them, nor should I necessarily accept being sworn at as “part of the job.” But I’m not sure whether it’s entirely true, and I’m glad there is an effort afoot in the medical community to help doctors learn how to better work with difficult patients. It takes a lot more work to take care of people like Mr. Z, but maybe that is just part of the job.
(PHOTO: CORBIS)
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Comments (2)
I feel that too polite patients are taken advantage of – not necessarily by the doctor – but their administrative staff. Example: I was sent to a well-known urologist in a possible cancer situation. After waiting to see him for over 2 hours (with an appointment, he saw me for approximately 5 minutes – during which he was interrupted twice by people walking into his office where we were meeting. He assured me someone would call me to schedule a cystoscopy. I waited patiently for three weeks for this call. I finally called to ask when it would be scheduled. When the call finally came, they had scheduled it in less than two days – and oh, by the way, could I go in for pre-addmission testing within the day and half. I was expected to drop everything in my business & life, to accomodate this doctor and his admin staff couldn’t even give me a few days notice for a procedure.
This is what happens when one is polite and patient. I would be happy to participate in my care, but please could these highly paid specialists respect that I have to make a living too?
When your doctor of 20 years no longer sits down to hold a two way conversation about the medical concern of the day and instead rushes out the door saying “we will discuss your laundry list at your next yearly exam”, then it is time to move on to someone who still has the compassion needed to be a doctor. If he had looked at my chart, he would have seen that he does not do a yearly exam except in very rare years. My new doctor is a very good listener and we get into two way conversations discussing my health plans. It’s so refreshing.