Whining Doctors and the Patients They Whine About
Of all the inane compliance videos, courses, and quizzes I have been forced to tolerate during my career, the only memorable one was this video, made by (for?) the Cleveland Clinic. If you haven’t watched it, it is actually worth five minutes of your time. It reminds me that I never truly know what other people are living with and that I am privileged to do what I do.
No matter what you think of us in medicine, we care deeply about our patients. I am always proud of the dedication to the health and well-being of absolute strangers. I have seen it from hundreds (possibly thousands) of colleagues during my career. In no other part of my life have I witnessed the tolerance and understanding of the foibles of our brethren.
But, in a way, patients are our bosses, and nobody can resist complaining about their boss every now and then. So, occasionally a doctor will whine about a patient.
So here, a little exercise. Some things I have said, heard said, or at least thought. Followed by an explanation.
“I can’t believe she is late again! If someone comes late to a 20-minute appointment, I’m going to run behind for the rest of the day, everyone else will have to wait, and then I will miss lunch.”
She is Sofia Teratova. She is 84 and takes two buses to get to clinic. On this day, there is a light snow falling. Her first bus is late so she misses the second bus and must wait another 15 minutes for the next one scheduled.
“Every time I see him his blood pressure is high and it turns out he is not taking one of his meds. What does he expect!”
He is Franklin Marshal, a 55-year-old man with 10 years of hypertension. The diagnosis worries him because his father, who also had hypertension, died at 60 after a stroke. He knows his blood pressure is controlled when he takes his medications, amlodipine and valsartan/HCTZ, regularly. The problem is that he has erectile dysfunction when he takes both meds. He discussed this with the doctor in the past and they changed around his medications a couple of times but that did not help. He felt like the doctor was a little annoyed that neither of the changes helped so he decided he would not bring it up. He sacrifices adherence on occasion for obvious reasons.
This is ridiculous, she tells me she is taking all the meds, and then I check the labs and her LDL has gone from 50 to 175. Does she actually think I won’t know that she stopped her statin?
She is Edith Pearson. Edith’s regimen includes:
Atorvastatin
Metformin
Rivaroxaban
Metoprolol
Empagliflozin
Symbicort
She is pretty sure the statin makes her feel bad. She knows the data about the benefits of statins – her doctor has recited it to her on many occasions. She often take the meds for a few weeks before appointments to “buff up her labs” but this was an unscheduled appointment, the office called and asked her if she wanted to take a late opening.
I don’t know why she comes to see me. There doesn’t seem to be anything wrong but she makes an appointment every couple of months. Occasionally she no shows.
She is Deepa Singh. Her husband moved to the US six years ago. Ms. Singh and he married three years ago and she joined him in Chicago nine months ago. He became physically abusive almost immediately. She finds the doctor caring and was struck that he has even asked how things were going at home several times. It almost seemed like he was encouraging her to speak up. She wants to discuss the situation. She thinks the doctor might be able to help. On the other hand, she is scared. The doctor also cares for her husband; that is how she ended up with him as her doctor.
This guy hasn’t seen me in 3 years and then he calls and just expects to be seen on a day that I am already overbooked?
This guy is Wallace Walker. He is 37. He is in very good health. At his last visit, he asked the doctor when he should see him next. The doctor said, “Three to five years would be fine. Just call me if anything comes up.”
I got his lab tests back yesterday, I can’t believe he is already asking to talk about the results. They are completely normal. People look up their labs, freak out over nothing, and then are upset when it takes you a day to call them.
It seems like a strange system, thinks Tom Walker. I get an alert on “MyChart” an hour after I have blood drawn telling me that my labs are back. There are a few of them in red. I have no idea what the labs are. MCHC? eGFR? Should I be worried? How long do I need to wait to talk to someone?
Photo Credit: Zachary Kadolph
Yes, you nailed it. I think some of the nasty attitude among physicians comes from the view of our jobs through a business lens rather than viewing being a doctor as a sacred calling. If you’re on a crunch to make RVUs then everything that isn’t billable seems like “extra.”
To supplement this poignant essay: I recommend watching the movie “The Doctor” (1991). A telling of a true story of a physician that gets cancer and gets the opportunity to literally see himself through his eyes as a patient and a doctor. A quote I’ve never forgotten, uttered when he encounters a dispassionate treating surgeon: “I used to feel the same way about a patient like me-when I was a doctor like you…”