Discounting Patients Creates a Lose-Lose

This is one of those post ideas that just lands in my lap and begs to be written.

I attended a presentation this week, and the woman sitting next to me began her tale of healthcare frustration — just as almost anyone who has sat next to me at a presentation, and learns what I do for a living, has done for the past few years. 

Her story was about her dad, and his interaction — or lack thereof — with his doctors.  Bottom line, he went to an appointment, his doctor dictated next steps, and then when her dad got home, he got upset and frustrated that he didn’t understand what he was being told, and he didn’t like the way the doctor spoke about him — like he wasn’t in the room. 

I call that discounting — the idea that the person being talked about is treated as if s/he isn’t there.  Or when the person raises an issue, needs clarification, or wants to complain, they are dismissed at hand, as if whatever they are talking about is fantasy.

Then this morning I received an email from an older woman who I’ll call Madelyn, who was humiliated during a breast cancer examination. She was not given anything to cover herself, and was then examined by a group of interns.  She was frustrated and embarrassed, and when she complained about it, she was told it didn’t happen.

Discounting at its finest.

I even observed it myself when my mother in law was in the hospital last winter.  The professionals would talk to my sister in law as if Mom wasn’t in the room, asking for decisions as if Mom wasn’t a part of them.  It made the hair on the back of my neck stand up.

Discounting — as if the patient was invisible!

These scenarios are repeated, in various iterations, everyday. And, I have no studies to back this up, but my guess is that certain segments of society suffer discounting more than others, e.g. the elderly, women, people of certain cultural or racial backgrounds, people who can’t read, and certainly children (although that is likely a function of who the parent is.) 

And the problem is, there is absolutely NOTHING gained by any party when it takes place.

Patients LOSE:  because they feel belittled, they don’t understand, and ultimately, they won’t comply with instructions because they don’t understand them — and — because they don’t feel important enough to comply either.  Way too often, their health doesn’t improve either.

Doctors LOSE:  because when a patient feels discounted, s/he will be angry, and will share that anger with loved ones and friends — and use the doctor’s name or the practice name.  Further, when the patient doesn’t comply, because the patient doesn’t understand, then the patient will get sicker — and go to see another doctor (at least I hope that’s the case!  I do know Madelyn did — and cheers to her for doing so.)

Why does it happen?  Blame lands in both camps.   Doctors may be arrogant, condescending, or sometimes they are just in a hurry!  Patients don’t command the respect they deserve — they behave as if they should be discounted, and then they are.

Eliminating the practice of discounting is the responsibility of both parties, IMHO (in my humble opinion!  OK, not so humble maybe…)

We patients must stand up for ourselves.  No matter what age or gender or cultural background, patients need to tell the doctor when they don’t understand and need to ask for further explanation.  If a patient feels discounted, s/he needs to point it out!  The key is to make sure the professional understands that they are doing the discounting.  “Doctor, please don’t talk about me as if I’m not in the room.”  Or “Doctor, I need to understand this or I won’t be able to comply with your instructions.”  Try not to get rude, I suppose — but be very clear about how you feel, and what you want him to do instead.

And patients — another piece of advice.  From the moment you walk into the exam room, don’t behave as if you should be discounted.  Patients who ramble, patients who don’t know the answers to their doctor’s questions, patients who behave as if they aren’t responsible or participative — they are the patients who invite discounting.  Examine how you communicate with your doctor and step up to the plate with confidence!

Madelyn needed to put a stop to her scenario and insist she be covered and insist the interns leave the room.  My friend’s father would have been wise to have an advocate in the room with him.  For patients who don’t find relief from discounting, the answer will be — find another doctor.

Doctors — if you are a “discounter,” then you need patients to bring you up short on this.  Most of you don’t even know you are doing it — it’s part of the wall you’ve put up all these years.  Not all doctors discount, in fact, I’m quite sure most don’t.  But I ask you to examine how you treat your patients and make sure you are not only inclusive of them in any conversation, but that you actively ask them to repeat your instructions back to you so you know they understand and are comfortable that YOU are interested in the outcome, and in them.

Frustratingly, I’m sure, the very doctors who need THAT advice never read or heed anything like this anyway.  In fact, they discount it.  Point made.

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6 Responses to “Discounting Patients Creates a Lose-Lose”


  1. 1 Caroline August 12, 2007 at 11:51 am

    HUGE problem…huge. And so easy to do, especially in situations where there is an interpreter.

  2. 2 Cinder August 12, 2007 at 12:57 pm

    Oh boy that is so true. Add to that anyone with a psych history.No matter how minor and/or long ago,prepare to be treated as though you are incapable of speech,any kind of organized thought processes or gray matter at all. Add to that they will consider your every utterance a falsehood or something to snicker at(in front of you). It doesn’t matter that you have been functioning well as a critical care nurse for the last 20 years YOU have already been stereotyped and will be discounted.
    If you actually do find a doctor after searching long and hard who actually listens to you,hang on to him for the rest of your life.

  3. 3 dxunknown August 12, 2007 at 8:48 pm

    I have to give a big thumbs up to a dentist I had once. After each appointment, you were given a questionaire to fill out and mail back in, no postage necessary. He was the most wonderful dr. I had ever seen and I feel those little cards had a lot to do with it! Just the fact that he would ASK speaks volumes! Of course we know that nothing like that would ever become “standard practice,” but wouldn’t it be great if it did? Oh.. and doctors where actually made to SEE the tallied results on a weekly basis!

  4. 4 Trisha Torrey August 13, 2007 at 6:03 am

    Amen DxUnknown!

    I’ve actually developed a way you can provide feedback, whether the doctor asks or not, called The Doctor’s Report Card.

    Here it is: http://diagknowsis.org/reportcard/index.htm

  5. 5 dxunknown August 13, 2007 at 11:22 am

    I LOVE IT!! In fact, I’m gonna press it!

  6. 6 martygrn August 14, 2007 at 9:24 pm

    As a pediatric ICU nurse, I couldn’t agree with you more on this point. I hope I show my patients the respect they deserve, though I know I fall in to this trap on occasion. It is very easy to do with children since they have no legal authority to make decisions for themselves. I now recognize where I myself have fallen in to this trap and will consciously try to not do so again.

    By the same token, I must stand with you in urging patients and families to speak up. I cannot count the number of times one of two things has happened. Either the doctors came in to the room, updated the family on all that was happening and asked if they had any questions or wanted anything further explained. The families say no, that they understand everything fine. The doctors leave the room and the family immediately turn to me and say “I wish they had explained X further.” The other situation is when I have had a family questioning me on different aspects of their care and I answer the best I can, but always tell them they need to bring up their questions with the doctor, as the doctor is the only one legally authorized to fully discuss their medical care and diagnoses. Later, the doctors come in, again go through what is going on and again ask if there are any questions or concerns. The family responds with a no. In this case, I try to always interject and say “didn’t you tell me you were concerned about X?”

    I have even overheard family members complaining about their care, the doctors, the staff etc. when up ‘on the unit’, they never voice any concerns whatsoever. I usually keep my piece at this point because the cafeteria is nowhere to be discussing patient care issues.

    I am constantly amazed when families will not speak up for the child. I primarily take care of infants or those too sick to speak for themselves (think sedated and ventilated), hence my personal reference always to families. I thank you again for trying to get families to speak up for themselves. I wish EVERYONE would take your advice.

    Marty Gister, RN


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