Sunday, March 8, 2009

Difficult patients or Difficult physicians?

I am reading posts on the Internet about "difficult patients" and how physicians get irritated at "difficult patients."

I have mentioned in earlier posts that I firmly believe that physicians do get irritated at patients, patient advocates, family members. I realize that physicians are only human and they either like people or dislike people. Those people are often patients!

There are some points that physicians and patients should keep in mind:

1. Patients hire physicians.

2. Patients must trust the physician without reservation. If the patient does not completely trust the physician then that patient should find another physician.

3. Physicians are not commodities. They are not interchangeable. As a patient, you must completely follow the physician's advice. Period. Don't argue a treatment plan with a physician. Don't be disrespectful.

4. Patients and their families are vulnerable and scared. Sometimes the patients are in tremendous pain. The stress causes patients to forget instructions and become confused. Even personalities change when people are under stress. Physicians need to learn to accept that and find a way to deal with it.

5. Physicians need to get used to questions and lots of them. Encourage questions. Write down the answers. Invite a PA or nurse into the room to assist in making certain that the patient understands. Sometimes a 3rd party can notice a confused look on a patients face. Addressing the confusing before the patient leaves the exam room can save you a phone call later.

6. Physicians must encourage a team approach to the patient's health. I notice that the best clinic doctors are the ones that interact with the patient instead of barking orders and abruptly leaving the room. I also notice that I have less questions and am more engaged in my recovery when I actually see the physician instead of just a PA.

7. Physicians must demand patient safety and continuity of care. Stop looking at the patient's presenting symptoms in isolation and as a snap shot. I guess that gets me back into the dangers of hospitalists.

Each and every time that my dad is hospitalized at Duke University Hospital there is a black hole of information between DUH and Duke Clinic. I have to spend many hours of time contacting Duke Clinic physicians in an attempt to bridge the black hole.

My dad's last hospitalization at DUH was three weeks in November 2008. I am still trying to coordinate the care instructions given to me by DUH medical personnel with Duke Clinic physicians. I am sure that my contacts irritate Duke Clinic physicians and surgeons. But even if I irritate the Duke Medical physician, he or she must never ignore the patient.

Regardless of how many times a patient or family members ask questions, gets stressed or phones the physicians office, there is never ever an excuse for the physician to ignore the patient.

If the physician gets to a point where he or she has made the clinical decision to ignore the patient or the patient's family then that physician should send a letter to the patient and refer the patient to another medical professional.

Being pissed at the patient and punishing the patient by ignoring him or her is absolutely not an option. Ignoring the patient risks the patient's life and safety.


  1. It is an issue in the health care setting. Call it bad patients or bad doctors, but this study calls to stop bad behaviors in the health care setting.

  2. Thank you so much for the comment and the great link. Everyone should read it.

    You (and the study) are right. The bad behavior. The disrespect. It all must stop. We all need to be a team for the most important person - the patient.

    Thanks again and take care.