… and I don’t blame (some of ) them.
I’ve seen several articles in the past few days about this topic — that doctors are feeling bashed and unappreciated.
Texas physicians blast anonymous complaints
Some doctors have their patients complaining on their behalf.
I’m even seeing this about doctors who are overseas — yes — where universal / national healthcare works: Top doc vows to clear name after witch hunt
There is nothing new about doctors getting upset at the fact that patient consumers finally have a public voice (through the internet) that helps vent their frustrations. Nor is it news that doctors don’t like lawsuits when they’ve committed errors. In fact, there used to be a website called www.doctorsknow.us that was established specifically to help doctors blacklist patients who they thought were too difficult. The website was taken down a few years ago, and it’s very interesting to read the comments made by doctors who were supporters.
[And, in fairness, this is not true for all doctors…. nor is it true for all patients. The takeaway here should not be doctors as a whole group — instead it should be only about those doctors who complain about their patients. ]
So we have patients complaining about doctors, and doctors complaining about patients and everyone complaining about the costs of healthcare, and the dysfunction of the “system.”
Yup – turns out this is another blamers and fixers discussion.
My observation: most complaints are rooted in mismanaged expectations that regard communications and the time/money conundrum.
Do you know of anybody who is happy with healthcare these days? Even if you have a dread disease, and get cured, you’ll complain about the cost, right?
Patients no longer “need” a medical error to get upset. The complaints I hear are that the doctor won’t spend enough time with them, or doesn’t answer all their questions, or always seems in a hurry.
Doctors are frustrated that their patients don’t understand the time constraints they are under, squeezed by health insurance reimbursements that are too low, so the doctor is forced to see more patients each day.
Doctors tell us our outcomes are less than expected because we aren’t complying with their recommended treatments — they complain that it’s often the patient’s fault when treatment doesn’t work because patients aren’t doing as they are told.
Doctors further complain that they are competing with the internet to diagnose and treat patients.
So here is some advice for patients:
Understand that the financial pressures on doctors are beyond anything they have ever been. It used to be they would see, maybe, 20 patients in a day (21 minutes average per patient). That meant they could spend a good deal of time with you to answer your questions. Now, if they want to stay in business (and we need them to!), they must see more like 50 patients in a day (8 minutes per patient) or they won’t have enough income. If they don’t stay in business, we won’t have a doctor to see — and that is already a problem — a shortage of doctors in many areas of medicine. We patients need to adjust our expectations, respecting a doctor’s time constraints.
Knowing you have less time with your doctor, prepare well to see him. Make a concise list of symptoms to report and a concise list of questions to ask. Manage your doctor’s expectations by telling him you have those lists. When he interrupts you (within an average of 18 seconds into your meeting) — then ask him politely not to interrupt. Remember — he’s used to interrupting, so you need to let him know that’s not acceptable.
Do not allow your doctor to provide an instant diagnosis. Make him think outside the box. When he provides you with a diagnosis, ask “what else can it be?” and ask him to explain why it isn’t the alternatives.
Approach your care in a collaborative way. If you have looked up symptoms or diagnoses or treatments on the internet, then warn your doctor that you want to discuss your findings. Manage his expectations that you want to have that discussion but that you are willing to make it a short discussion.
Comply with your co-decided next steps. If you and your doctor agree on what those next steps are going to be, then you have no excuses but to comply. If you run into problems, let your doctor know immediately, otherwise he will think it’s your fault that you aren’t getting better.
Here is some advice for doctors:
Please understand — I GET that you have less time per patient. I GET that your reimbursements squeeze you. I GET that you went to med school and the internet didn’t. I GET that patients are demanding more from you when you have only less time to give. I GET that your practice approach has had to shift with these new realities. I offer this advice to make your lives easier:
You will be less inclined to find problems with your patients if you begin to respect them more. They are sick or hurt. They are scared. They are looking to you for answers and guidance. You are treating them like cattle. You are interrupting them. You aren’t thinking outside the box. And yes, I realize that in fact, if you don’t do it right the first time, you just get paid a second (or third) time for doing it again. But respecting your patients should still come first.
Respect also means it’s time to stop interrupting. I GET that you are interrupting because you know your time is so short — but don’t. If you want to speed things up, then tell your patient that’s what you are doing. “Mr. Jones, please tell me quickly what you learned because I want to spend our time finding the answers for you.”
Understand that the internet is here to stay. It’s not going away. Instead of fighting it, or getting upset with it, why don’t you guide your patients’ use of it? Manage their expectations about YOUR reactions. Provide them with a flyer about the use of the internet that asks them not to bring you stacks of printouts, and guides them to good websites for their use?
When patients don’t get better, don’t automatically assume it’s because they didn’t comply. Yes, I GET that compliance is a big issue — but assuming non-compliance is once again, a respect issue. You can get to that information by asking gentle questions mixed in with symptom or test result questions. By assuming non-compliance, you instantly put your patient on the defensive, and that throws up more roadblocks.
Advice for all:
Next time you are tempted to complain about your doctor, or your patient — ask yourself if the basis stems from communication, or if it stems from time/money constraints. In either case, the “fix” is not the opposite party, the “fix” is your approach. Take a deep breath — then see if you can fix it.
That’s what fixers do. Because complaints and blame don’t get us anywhere.
| ……………… | |
 |
Want more tools and commentary for sharp patients? Sign up for Every Patient’s Advocate email tips Or link here to empower yourself at |
| ……………… |
Every Patient's Advocate 
You expect a doctor to make a competent diagnosis with an 8 minute visit? Are yo serious? Take me half that time to take my clothes and shoes off… Never mind the small talk…
Please HELP! Time is of the essence:
DIARY UNTIL I LOSE MY COBRA INSURANCE 8/22/09-sent to President (WH), .GOV site, all representatives, Sacramento: Center for Infectious Disease, Insurance Boards, SSA representative, insurance carrier, news outlets and anyone else that will listen.
08/09/09 Sunday I am understanding NOW why I am losing my COBRA benefits after 18 months and not receiving the extension. I am losing my insurance because my carrier is in Texas. Therefore, they are exempt from California rules and regulations. All of my Colleagues are losing theirs as well. I have also discovered my PCP is a Board Member for a Hospital that is being investigated and shut-down. I wish he would have referred me elsewhere 9/08 when I was very sick because he had other things on his mind.
08/08/09 Saturday Results in TODAY. Two years+ of telling my doctors I was sick. It took me paying cash to a Homeopathic to test: Positive Phase I and II Q-Fever. I am looking at 1.5-4 years of therapy with 10 business days left on my insurance. Needless to say, I don’t know what to do or who to go to with this test. I am unbelievable scared and sad.
08/08/09 Saturday Today I am still in bed to alleviate pain. My gastric abscesses and Interstitial Cystitis are flaring with pain and fatigue. I have severe lower stomach and back aches. I am meditating to keep the stress at bay.
08/07/09 Friday Today I received a call from my SSA representative here in Corona, CA. Doesn’t look like I will receive a ‘Notice of Award’ for permanent disability to save my COBRA insurance in time. Most of the doctors are NOT responding to their inquiries. She says it doesn’t look good. I let her know I was not EXPECTING-therefore I wasn’t crushed but I was HOPING. I thanked her for the update.
I am on my back in bed to alleviate the leg pain. Oh, by the time I realized the new PCP hadn’t called me back it was 1 in the afternoon and they had already left the office.
08/06/09 Thursday Today I had an urgent visit to my heart doctor. Severe pain and swelling in the left leg. An urgent LE Venous Doppler, Bilateral was negative. EKG fine. She says to pursue the Infectious Disease as hard as possible until 8/22/09. She says: you never now, it could be something cash can take care of. Then she nodded: who am I kidding. I thanked her. She gave me a referral for a new PCP. I called and they said they would call me right back.
LETTER TO THE WHITE HOUSE-08/07/09 Friday
I am a Republican through and through. However, my story is SAD. I have Blue Cross Blue Shield PPO COBRA I pay $750 a month for. Unfortunately for me, it expires 8/22/09. I have been VERY SICK. Last year alone, my out-of-pocket health care costs were $32,000. Because of my illness, I have had to apply for SSA (still pending). I have gone around the loop with my ADP COBRA provider, my employer and my current insurance carrier. They say I cannot have the 11 month extension because my employer’s corporate office is in Texas and they do not have a mandate for California. My insurance carrier won’t offer me a price on continued coverage because I am too sick. I can’t buy other insurance because of my multiple diagnoses. And, my husband can’t find full-time work with benefits (laid-off after 18 years on the job).
My plight started 05/07 with a dental injury to the jaw. Immediately after, I had mouth problems, then sinus, then brain, partial heart, possible pulmonary, gastric problems and now spinal cord. I’ve been around the circle to EXCELLENT doctors. Everyone wanting their own tests.
My Rheumatologist has diagnosed: Fibromyalgia, Chronic Pain, Neuropathy and Myopathy.
My Neurologist has diagnosed: Chronic Fatigue Syndrome, Epstein Barr Virus, Neuropathy, Myopathy, Pansinus Disease and Dystonia.
My Gastro was hoping to diagnose me with Crohn’s. However, pathology says it isn’t Crohn’s.
My Urologist has diagnosed me with Interstitial Cystitis.
My Orthopedic has diagnosed: Cervical damage and Lumbar Arthritis.
My Infectious Disease specialist won’t see me anymore. I have become the OMGoodness here she comes patient.
My PCP of 22 years has completely written me off as an OMGoodness here she is patient also.
I am just now starting with a new circle of doctors. However, with my COBRA ending 8/22/09 and no one willing to sell me a policy, I am destined to die undiagnosed without a treatment plan.
All my specialist’s individually say: you need to go back to your Infectious Disease specialist because there is something wrong. But of course, he won’t see me. Odd hand-written letters delivered to my door.
I’ve lost nearly all of my savings as I have been taught to live within my means. I bought my Condominium in 2004 with a $75,000 down payment. I was taught investing in my assets is a great thing. I may lose my Condo now as I am upside down with my Equity ratio. I did the right thing and look where it has gotten me.
I am a very personable/pleasant 50 year old Caucasian woman. I am very frightened as to what the future brings for me. I’ve actually asked my doctors for Hospice so I don’t have to leave the house and be treated with such indignity. However, they don’t have a diagnosis for that. Nor, do they have a diagnosis that will save my life right now.
By blood/serology is crazy. My Eosinophils, Lymphocytes and Triglycerides are off the charts. My Antigens: RNP, ANA-A and ESR are double. I go to Emergency sometimes three times a week.
What am I going to do in 2 weeks? If my body finally decides to give them the clue they need, I will die at home with no help and in unimaginably worse pain than I am suffering now.
I was hoping SSA would give me a ‘Notice of Award’ before 8/22/09 as if I get that notice into my ADP COBRA insurance hands before the expiration date, I will be allowed to continue paying $750 a month for another 11 months.
My mother past away,During surgery.The doctors told my mother that she had a tumor on her voice box.After cutting my mothers throat,The doctor realize,that no tumor was their.My sister meet with the doctor.While in the meeting.The doctor said.Inrefrance to my mother having cancer.If it look like a duck,Or walk like a duck.It’s a duck.I wanted to just die!!!
Neurologists in wilmington NC have banned together to refuse service to medicare patients. It was hurting thier bank balance.
There is only one self proclaimed neurologist left there to see.
You know I really don’t care if their kid goes to Harvard or Yale.
I don’t care if their Yatch is 50′ Or 80′ Screw them there are sick people here. we need to get real Doctors from somewhere else. These bastards have gotten to big for their heads, which were twice the size the should have been to start with.
Oh I might add there is one Jack of all trades in Jacksonville who leads you to beleive he is a cradiologist who is a fraud. A real jerk in every sence of the word. That would be the grand and wonderful hatefull stupid jackass Dr. She