I am disturbed by Dr. Brian C. Joondeph’s article, “8 Things Doctors Secretly Want to Tell Their Patients” (http://www.kevinmd.com/blog/2017/04/8-things-doctors-want-secretly-want-tell-patients.html). While I understand the good doctor/author wishes to share the physician perspective on the topics in question, it strikes me that this piece exudes a tone of near resentment toward patients – toward the “patient as center” philosophy. At the very least, it does not scream “patient as partner” to me, nor does it seek to reconcile patient and physician. It simply points out perceived patient misdeeds and makes no attempt to reflect upon the possible reasons behind patient “shortcomings.”
I understand the challenges physicians face, and it is not that I find fault with those who wish to discuss the physician condition under our current healthcare system; nor do I wish for my physicians to suffer. I would like for my physicians to be happy, fulfilled, and well-compensated for the care they provide. I have had mixed experiences with doctors, but most I have encountered have been dedicated professionals who have provided skilled care and have treated me with dignity and respect. I sympathize with physicians who must tolerate long hours, overcrowded schedules, under-compensation, and less-than-reasonable patients. But, out of necessity, if nothing else, healthcare must be centered on the patient, as it exists to serve his needs. And in any case, we should not be at war, intentionally antagonizing each other and manufacturing tension and drama. Should there not be attempts at mutual understanding?
To this end, let’s begin with the physician’s points, and address them one by one from the patient’s perspective…
1. “I’m worried about health care reform, too.” – Though you state that you appreciate the challenges patients face under the ACA (or any other healthcare program), I am not certain you actually do. Your worries center around your financial concerns and the possible closure of your practice, but mine revolve around my health, my very life. My finances are already in ruin because I am too ill to work, and my medical bills continue to mount. I am barely getting by as it is, and if I have no (or very limited) access to affordable care, I will die. You will simply lose your business.
2. “If you’ll be late or need to cancel your appointment, please let me know.” – This seems reasonable, and I will do my best; however, I expect the same courtesy in return. If you are running late or will be rushing through my appointment in an attempt to “make up time,” please let me know so that I have the option of canceling. My time is valuable, too, and I have likely gone through a lot of trouble to get to your office in my sick and weakened state. Lengthy waiting room times, when one is vomiting, feverish, and one the verge of collapse, do not help the situation. And please think twice about canceling my appointment at the last possible moment. I do not appreciate prepping for a colonoscopy only to be told a couple of hours prior to the procedure that the doctor is “running behind” so we simply must reschedule. Please understand, also, that, like you, I am not always able to give 24-hour notice of cancellation. My life is chaotic. I may awaken to a sick child, a car which decides not to run today, or any other number of unexpected and unplanned catastrophes. Life is not always perfectly predictable. Oh, and I receive no compensation when you cancel.
3. “You really need to… [fill in the blank]” – Yes, I am probably already well-aware that I need to… [X]. Now, I realize that you feel it is medically appropriate to tell me what is already very clear to me, but it is not necessary to do so in a condescending, hateful manner. Often, it is the tone which is the issue and not the statement itself which I find offensive. Believe me, there is a difference in saying, “You might really consider dropping a few pounds” and “You are fat!” And in any case, your “edicts” are, in truth, merely recommendations to me, and I may very well see things differently based upon which quality of life aspects I wish to emphasize and which goals upon which I choose to focus. You do not have the right to make unilateral decisions for me. And one final point: not all of my health issues can be attributed to unhealthy lifestyle choices. Sometimes, through no fault of their own, even when they have done everything right, people get sick. They get infections, viruses, and diseases which were not caused by living a sedentary lifestyle or eating too much junk food.
4. “Think before you call us.” – Well, the next time I am vomiting non-stop and scared out of my wits by the pain, I will try to consider how this might disrupt your evening. That middle of the night call you hate receiving? Got news for you: I hate making it, and if I were taken more seriously by ERs and physicians alike, I likely would not be taking this approach. (Please see “Whatever Happened to Good Old-Fashioned Outrage” at http://melissarvh.blogspot.com/2017/02/whatever-happened-to-good-old-fashioned.html.) And while we are at it, I would greatly appreciate it if you would think TO call me. I deserve timely notice regarding lab results over which I have been wringing my hands with worry. A follow-up call to check my status after a major procedure and reminder calls regarding upcoming appointments would be nice as well.
5. “Be polite to my staff.” – Politeness should always be the goal, of course, and that should go both ways. Please also inform your staff not to take their frustrations out on ME. Yes, that happens! Eye contact, smiles, a simple “please” and “thank you” and an apology for long wait times would be most appreciated. Please remind them I am a unique individual and not a number, and that though they might have asked the same set of questions to a hundred other patients, they have not asked those questions to me. So, please forgive me and exercise just an ounce of patience should I ask for clarification or elaboration.
6. “I can’t always run on time.” – Nor can your patients. Please do not assume I am not concerned about getting to appointments. Many times, I have waited weeks, even months, to get in to see you. I do not take that lightly. So, if I am a few minutes late, it is not because I set out to ruin your schedule; rather, I was likely interrupted and delayed by one of life’s unexpected situations.
7. “Saying ‘thank you’ goes a long way.” – As mentioned above, it most certainly does, as does your kindness toward patients. We all wish to feel appreciated. Without me, you would not have a job, so please address me as a valued individual client. I would love to hear how grateful you are for your loyal patients, like me.
8. “I’m only human.” – As are your patients. As a matter of fact, we are sick humans. I cannot always be at the “top of my game” when I do not feel well. I am weak and struggling, sometimes in a fog, and, try as I might, I do not always put my “best foot forward.” Neither do I welcome your criticism and judgment for my transgressions. I am not apathetic or generally unkind; you see me at my worst. I am doing the best I can, given the circumstances. My apologies for the times I am less than perfect regarding the social graces.
In addition to the responses above, I beg you to please consider the following subjects we, as patients, would (maybe not so) secretly like our physicians to know as well:
1. I am frightened and unsure. – I have just been diagnosed with a disease or condition about which I know nothing – not the cause, the possible treatments, or my prognosis. I have no idea how this will alter my life, and I am terrified to hear the answer. In fact, I know so little about my condition I can barely formulate basic questions for you. I fear you will mock me or that you will not believe me. I fear you will not take my concerns seriously or will not focus on the aspects of my care which are important to me. I fear my condition will worsen. I fear I will die.
2. I am overwhelmed physically and emotionally. – In addition to my fears about our upcoming visit, I am coping with the very real daily negative physical effects of my illness and the stress related to it. How can I cope with these symptoms for the rest of my life? How will I work like this? How will we pay our bills? Will I be a burden to my family? Will I survive to see my child grow up? These matters weigh heavily on my mind, and I am drowning in worry.
3. I am not stupid. – It may take some time for me to adjust and learn, but I am perfectly capable of understanding complex material and processes when I am comfortable with the language and terms and am given proper information. I can make informed choices and wish to be presented with all my options as well as the potential risks and benefits. I welcome your educated recommendations, but it is ultimately my life, and these are my choices. Furthermore, rather than admonishing me to “stay off the Internet,” you should be encouraging me to do additional research regarding my condition and its possible treatments. I need to understand what I am up against, and I cannot always trust that my physicians have the latest or best data about my condition, especially if it is rare. Please welcome my suggestions and engage me in reasonable discussion as to whether the questions I raise are sensible concerns and the treatments I present are viable options.
4. I can handle the truth. – Please do not hide information from me. I want and expect the whole truth about my condition. Yes, I might be upset, but once I have a chance to process the information and evaluate my options, I will be just fine. You do not need to hint around, speak with my family as if I am not in the room, or downplay the nature of my condition. In addition, please do not attempt to define for me the seriousness of my illness; I will decide that all on my own. That is not up to you to determine because your life is not the one impacted by this illness.
5. I wish to be believed and treated with respect. – I should not need to “prove” I am experiencing the symptoms I report to you. If I am in your office, it is a pretty safe bet that I am, indeed, struggling. When you smirk, seem uninterested, or dismiss my symptoms without further evaluation or discussion, it is difficult for me to believe I am being heard. Further, please do not assume that because only a small percentage of the population is afflicted with a certain condition about which I am concerned, I could not be in that small percentage. My fears may be justified. And, finally, please do not tell me, “I wouldn’t worry about [X].” You wouldn’t, but I do. Explain to me why you do not believe I need further examination or evaluation.
6. You are not seeing me at my best. – You are most likely seeing me at my worst. I am weak and ill, and your personal situation and feelings are not my chief focus. I am normally a very nice person, but these are difficult times. Yes, you deserve to be treated well, and I should be polite under all circumstances, but I sometimes neglect the social graces when I am on the verge of a breakdown and in the middle of a health crisis. Forgive me my failings and please do not reciprocate.
7. I don’t want to be here. – I am not inventing symptoms because I seek attention or have an unmet psychological need. I am not an addict seeking drugs for a “fix.” I am not lonely or in need of your company. I do not wish to waste your time or my money. I am in the midst of a genuine medical predicament and could use your help rather than your accusations and scorn.
With a little bit of effort and adjustment in perspective by both parties, many of these issues could be resolved. Physicians and patients should not be at war. We share many goals, and we are trapped in the same faulty healthcare system. Can we not find a way to understand each other?