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Top 10 Ways to Annoy Your Doctor (By accident vs. on purpose!)

September 9, 2010

That is one annoyed doctor!

A few months ago, Jenny Stowe sent me a link to her article about 10 Ways to Irritate Your Doctor, wanting me to re-post it. As far as I can tell, it’s a marketing site which sells online Masters’ degrees in healthcare. One way to Irritate Your Doctor that isn’t included in the post is mis-spelling/saying their name. (I actually really don’t mind this as it  happens a lot to me because I have a funny name that doesn’t sound as it is written). She addressed me as “Jaotte” – my first and middle initial and my last name mashed together, like the front of my e-mail address. Spam? Yah, but I’m indulging it.

Swamped with other endeavours, I hadn’t been blogging much, but finally I had a look at the article. Hmmm. While some of the advice is reasonable, I was rather leery of sharing it. Yes, the overall level of respect for physicians seems to be in decline; I do want to be regarded as an expert but for me, ‘gentle scepticism’ is preferable to ‘total obedience’ in my patients.

My blog is all about transparency, being human, making myself (and the profession) accessible, etc. Sure, I’m a pompous, proud nose-in-the-air physician at times, but I get humbled pretty quickly. Every once in a while I think “ohhhh yeahhhh, I’m a d-o-c-t-o-r!” and other times I think “oh yah, I’m a doctor? how did that happen!?”

I didn’t really want to endorse the article but then I saw value in explaining why it rubbed me the wrong way.

My response to Ms. Stowe:

. . .

I’m sorry I didn’t reply to this earlier.

I did have a read and would have been uncomfortable linking to it from my blog. I think it promotes the view that physicians are condescending jerks.

I would say that nearly all of my patients have done or will do one of those 10 [“annoying”] things at some point; it is a physician’s job to treat the patient and the disease, and remembering the whole person may involve redirecting their questions (or noticing that they are asking a lot of questions – maybe there are other worries or stressors on their mind?), asking them to make a follow-up appointment for other issues, excusing a part of the family from the room, etc. It is very common for patients to describe symptoms vaguely or to not know their medications, but you know… diseases don’t read the textbooks (and neither do patients!). I do want my patients to be empowered but I’m not averse to being the one who guides them toward taking ownership for their health. I have a lot to learn in this regards; motivating patients to take responsibility is one of our greatest challenges, but it’s also such a joy when I get to watch it unfolding.

I looked online for more tips regarding this and found my favourite How to Avoid Annoying Your Doctor on E-how has my favourite:

Avoid . . . vomiting on your doctor.

Now heck, I do get “annoyed” or frustrated by patients sometimes, but as my self-awareness improves, I begin to know that when I’m irritated, I’m missing something. Maybe I’m not giving the patient what they need? Maybe I’m not following my preceptor’s super role-modelling (using reflective language, “you seem like you are really upset/asking a lot of questions/have a lot of concerns” or acknowledging that you aren’t sure how to help, etc.). Maybe I’m not seeing the ‘red-flags.’ “Is there something I’m missing?” usually saves me.

I’m young and inexperienced; I kind of suck at this stuff. However, I’m honest with my patients – I say “I don’t know” a lot, or “I’m just going to go ask someone with more experience” – and I’m learning. My evaluations always say that I’m thorough and empathetic, but I know that I’m critical of patients who aren’t motivated or who behave in a way that doesn’t seem to acknowledge that I’m trying to help them. To be honest, I could use a course 101 in Self-Awareness, and probably 202 in Motivating and Empowering Patients. The other thing that comes to mind is that most doctors (unless they are failing at wellness/self-care) are patients too! Hopefully we remember that when we set expectations for patients.

If you’ve read this far, you deserve a reward: For those times when you are trying to piss off the doc, there is a list for that too! It’s written from a primary-care physician’s perspective, and it is bang-on hilarious. With gems like this:

4.  Smoke a pack of cigarettes or several cigars just before going to the doctor’s office. Then when you are asked if you smoke, say you don’t.

you’ve got to chuckle! Check it out – Dr. Rob at Musings of a Distractible Mind has plenty of other silly stuff.

6 Comments leave one →
  1. September 9, 2010 2:26 pm

    I absolutely love this post. You are the kind of doctor I would like to have on my team. I have an enormous amount of respect for professionals who approach their patients/clients in a spirit of partnership.

    Do you think that your medical education fostered your perspective? Or is it something that you bring from your life experience?

    • September 9, 2010 11:25 pm

      that’s very kind
      I should say I _try_ to approach patients in this way. It doesn’t always happen.

      On of my favourite questions is: “does that sound reasonable?” after I lay out a plan. I’m not sure it’s the exact question yet but it is a start.

      Yah, I think the culture is changing. We steer away from paternalism and more toward “patient centred care” as a profession now. Much of this does come from my med school teaching. Also a bit from my personal thoughts – I’m not smart enough to make the decisions for other people. I try to sometimes, but it (selfishly) feels good to unload responsibility that probably never should have been yours to begin with.

  2. doctorblue permalink
    September 9, 2010 6:13 pm

    Loved your post. I can only surmise that doctors see a lot of disrespectful, self-centered, egotistic and obnoxious patients. Please keep in mind that not all patients are maniacs. Doctors need to be discerning and not paint each patient with a broad brush. Apparently, the many doctors I saw over a lifetime thought I was making symptoms up. Turns out I was telling the truth. I became disabled unnecessarily at age 50 because doctors failed to diagnose an intestinal blockage that led to a plethora of disease states including a degenerating and compressed spine.

    It was only after becoming too ill to work that I realized how responsible patients need to be about their health. In order for me to get proper medical care in the U.S., I had to gather my medical records, read everything I could get my hands on about the practice of medical care, research the significance of all the positive test results that were never mentioned to me, self-diagnose, research which relevant physicians were competent, qualify for Social Security Disability and Medicare in the U.S. then travel to the Cleveland Clinic, where I got the necessary surgery seven years after I embarked on this journey for what was a congenital defect no one believed I had because they couldn’t “see” it.. I blog about my experiences at http://doctorblue.wordpress.com.

    Understanding the system, my disease states and knowing what therapies I need to get better enabled me to establish an excellent report with some competent physicians. The #1 trait these doctors share is their ability to listen to their patients. And they take time to listen.

    I found that I am not an anomaly after becoming active in patient medical mistake support groups. In fact, medical mistakes occur much more frequently than reported because few patients can afford the cost of litigation, particularly after having spent their last dime (in the U.S.) seeking competent medical care.

    I don’t understand why doctors don’t have little pamphlets they can hand out with Patient Rules of Behavior that clearly states that the patient is responsible for the patient’s well being and explains what that means and cites books the patient should read to get a realistic perspective on medical care.

  3. September 10, 2010 12:37 am

    Thanks for your comment.

    It sounds like you have faced a lot of frustration with the system. We are very fortunate in Canada to not have HMOs/insurance/etc. dictating treatment. No one imposes a rule about which doctor you can go to, and I think that’s a great thing. People need to find the right match and I think that a good therapeutic relationship can even sometimes overcome bad medicine.

    I don’t know about your medical case but from your writing I can see it was a long journey to figuring things out. There remain many diseases that we can’t identify or classify/label, which makes appropriate treatment difficult. Another important part about transparency in medicine is, as a patient, making a safe environment for your physician to say “I don’t know” at some point. We don’t want to say this, but we have to more often than one might think. “Comfort with uncertainty” is an essential characteristic in a person applying to Family Medicine residency, especially.

    We never figure everything out – the usual course is to rule out all the big and scary things, all the common or easily correctable things, and then to follow along from there. Unfortunately, some patients get dealt a terrible hand and we do not recognize their disease or perhaps we don’t have the means to treat it. Sometimes acknowledging that we “just don’t know” can make it easier to accept and live with the disease. I can’t find the reference but I read a doctor’s blog post recently that talked about how satisfying it was for both he and the patient that they labelled her unknown disease as some goofy name. [I thought it was Dr. D at Ask an MD but i can’t find it!]

    Mistakes do happen and misdiagnoses persist. Doctors and other HCPs should be advocates when they can, in this regard. But sometimes, like in your case, the patient has to take on that advocacy themselves.

    I agree with you about patient empowerment. I actually wrote something about that for this post, but cut it out (to be placed in a post of its own at a later date). I think doctors and patients should have a kind of contract that encourages the patient to take responsibility for their health. I’m gonna have a look and see if there is any literature about such contracts.

  4. anonymous permalink
    September 18, 2010 4:32 pm

    As a patient who has experienced a misdiagnosis and an inappropriate surgery, I found your article of particular interest. In my case, the misdiagnosis and surgical misadventure were not disclosed by my treating physicians. I experienced blame shifting in the form of berating and withdrawal of services from the PCP and the specialists. It took quite some time to find another doctor willing to tell me what actually went wrong and to embark on a corrective surgery to fix it. In the interim, I was trying to understand how I could walk the fine line between being assertive without being too aggressive in my pursuit of good medical care.

    By and large, Doctors are still taught in a rapid fire and relatively mechanistic framework to find and fix a problem. Many have the expectation that not solving the problem is a moral failure. From a philosophical perspective, I believe that doctors are internally driven to succeed and that this personality characteristic is exactly what makes a good doctor. At times, this is also a double edged sword because the definition of success is directly tied to clinical results (independent of external issues like insurance company mandates or even litigation). A patient’s willingness to accept ambiguity (an external source of validation for the doctor) usually has a marginal impact in the doctor/patient relationship. If a doctor feels ineffective or at fault in diagnosis or treatment, then the patient suffers from the doctor’s negative feelings: either in the form of dismissive behavior or in negatively nuanced referrals (e.g. hypochondria or mental illness because “nothing can be found” to explain the symptoms). Often, these are the same patients that later manifest with a serious condition and then instill more guilt in the conscientious but frustrated doctor. It is a downward spiral. Sometimes doctors need more support.

    While I do believe in the existence of difficult patients, I am now of the opinion that due to the power/knowledge imbalance between doctors and patients and the fact that most truly ill people are apprehensive (and dare I say moody) the physician really does have primary responsibility for managing difficult encounters. If appointments are too challenging, then the doctor has a responsibility to arrange a patient transfer to another doctor who is a better fit. Preferably with clear, positive communication and thoughtful coordination and not with a form letter abruptly terminating services. I do not view this as a paternalistic stance, but rather a necessary component of pragmatic professionalism. Most patients do try to please their doctors while simultaneously struggling to get their needs met. Because of the unique nature of this relationship and the inherent vulnerability of an ailing patient, having the insight and fortitude to confront or leave a doctor is a very difficult if not impossible thing for many patients to do.

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