Published in last month’s issue of the journal Pain was a study which found that if you were deemed “likeable” by your doctor that your pain was more likely to be taken seriously than if you weren’t deemed “likeable” in which case your pain was more likely to be ignored or underrated.
It shouldn’t be, but it’s true. Doctors, being human, have emotions as well. But professionalism, when applied, should always retain objectivity and a pathway of discovery, to the patient’s benefit.
I remember my first year in practice, while standing at a nurses station in the hospital, unavoidably overhearing a physician in his seventies having a terse conversation with his patient on the phone. His voice grew louder. He became more animated, and agitated. Obviously whoever was on the other end of the line was either not listening, not complying, or was demanding. Finally, in
exasperation he shouted, “Well, hell, if you don’t want to take it, you can go jump in the bay!” And then slammed the phone down. I remember thinking, ‘My God! How could a doctor talk to a patient like that?’ Of course, it was an unprofessional and inappropriate response. One can only imagine the next time they met how the doctor might view things differently.
I’m embarrassed to confess on rare occasions I’ve had that gut-like emotion to arise. I would think most doctors have experienced something similar, to some degree, at some point in their careers. It can skew and affect a physician’s decision making, unfortunately to the detriment of the patient.
Dr. Jerome Groopman wrote a book called “How Doctors Think” and says that many of the errors doctors make come from the emotional side of things. He said that doctors make mistakes when they find certain patients annoying.
But the reality of it is that patients are no different than doctors,
lawyers, dog catchers and plumbers. Some are agreeable and some are not so agreeable. The same article found that the most common thing that annoys most doctors are patients requesting unnecessary medications. The second most annoying thing is patients with unrealistic expectations. Doctors are also likely to get annoyed at patients who are not so much interested in listening to their diagnostic opinion as they are having confirmed their understanding of what they believe to be their problem based on retrieved Internet information, or from what Aunt Tilly might have told them.
Physicians respond to the same emotional cues like everyone else. Like in any walk of life, we naturally measure our responses to people who approach us in a particular manner. Arrogance draws out one emotion. Shyness another response. Congeniality another. There’re various ways in which we subconsciously react to people. The patient-doctor relationship is no different than the other relationships we form in spite of the training of a health
professional to be as objective and non-judgmental as possible.
Just this week I saw a young single working mother, going to school to better herself, and raising three kids. Her plate was full to say the least. I don‘t know how she did it. I continue to be amazed and often in awe at how some single mothers working, going to school and raising kids do it. But she was obviously stressed out and distraught at the window, and demanded to be seen without paying even a discounted fee. She became angry and loud, and then became profane, f-ing this and f-ing that. Luckily, she was the last patient at the end of the day and no one was in the waiting room. I was on the verge of discharging her from care until she calmed down enough to let me understand the dynamics of what it was in her life that needed attention, which was several things. But at the end of the visit, fortunately she was able to see things in a different light and perspective; she was even apologetic for her behavior. This is an extreme case of a patient presenting with negative attributes. But I’m sure a lot of patient-doctor encounters are not able to get passed the ‘in-your-face’ and ‘give-me-what-I-want’ approach some patients take.
In this Age of Information it only takes a couple of clicks of the mouse and you can read about whatever symptoms and diagnosis (you believe) you have. Imposing upon a physician a certain diagnostic or treatment path at the exclusion of a more sound and standard of care approach is not helpful to the patient and can delay arriving at the cause of the real problem. I call caving in to this type of ‘give-me-what-I-want’ behavior prostituting the profession. Patients perceive that since they paid the doctor his/her fee, they should get what they want, whatever they want. I would think most doctors bristle at this approach. For the physician who caves in to these demands, he runs the risk of
being liable for any adverse events that were not the result of his choosing. If he holds to the professional sound approach, contrary to what his patient prefers, the patient is inclined to go elsewhere, perhaps doctor hopping till they get what they want.
The best approach, and the approach used by most patients, is no different than what we all do when we take our vehicle in for repairs, which is to communicate the vehicle’s symptoms to the mechanic and then submit to his expertise. I can’t imagine people telling the repairman, “Listen, I think the carburetor needs replacing, and the fan belt too. Leave the distributor alone and the exhaust system too, but take a look at the left manifold and if it’s got more than ¼ inch sludge then replace the valve on the hyperlock.” If you’re like me, not knowing a damn thing about how to fix a car or truck, you tell him everything you are experiencing to be a problem, the noises, the car’s behavior in various conditions, it’s response to ignition, starting, acceleration,
braking, and parking. And then you submit to his knowledge and expertise.
Of course, this saw cuts both ways. I’ve talked to patients who’ve
complained that the previous doctor seemed disinterested, aloof, or unengaged in what they were communicating. There’s no doubt some doctors can go through times during which stress comes to bear on their attentiveness or lack of it.
Making demands (rather than sharing information), or talking about the negativity of past encounters (rather than being objective yet nonjudgmental) is probably not the best way to start off a working relationship. Clarity of communication is paramount.
Of course at the end of the day, living in the land of the free, a patient can always choose another doctor (and they do) if they don‘t perceive things to be working. And the doctor can always discharge or refer a patient to another doctor (and they do). But most disagreements between a doctor and patient can, like other relationships, be remedied or reconciled. But like other relationships, it often takes communication, a deep breath, and a clear head.
Being nice can make a difference, too.