Doctor D has been remiss in his blogging duties.
AskAnMD is going into hibernation.
Doctor D has been remiss in his blogging duties.
AskAnMD is going into hibernation.
A reader asked her specialist a question that befuddled him, so she wrote Doctor D this question:
How is a doctor allowed to mess around with body parts he doesn't understand?
Doctor D always loves to read your thoughts in the comments.
Do you think that Dr. D is over-stating the uncertainty of medical science?
Patients and Heathcare People: How has this Myth affected you?
Doctor D gets lots of emails from students considering medical school.
Hey, if the practice of medicine is your dream then you should go for it, but be forewarned it isn't sexy or glamorous like on Grey's Anatomy. It is years of drudgery in which helping patients and feeling awesome about yourself will be the exception rather than the rule.
But I pray to God you never go totally off your rocker and spend your precious days off making videos like these:
Doctor D has more relevant material than silly parodies of parodies of parodies, but unfortunately not the time to post it right now.
He's also about 2 months behind on answering AskAnMD emails. Feel free to chastise him the comments!
Find another doctor. If one doctor-patient relationship didn't work there are lots of other fish in the sea. Move on!
Bad Patient Syndrome is a prejudice, and like most delusions prejudice is most dangerous when you try and expose it. Prejudice is subconscious. Docs don't recognize we think this way. Your confrontation or insisting on your innocence only confirms our suspicions that you must be a manipulative asshole.If you directly attack a delusion it will only entrench itself. You have to work on it subtly until it is the prejudiced person who realizes they were wrong. Your doctor must think they discovered you aren't a bad patient on their own, without any confrontation from you at all.
The best way to approach this is to imagine yourself in the doctor's shoes. Ask yourself, "If I suspected someone was manipulative, dishonest, or crazy would this behavior seem to confirm my suspicion?" If the answer is YES or even MAYBE then don't do it!When a patient suspect they're being unjustly labeled as being a bad patient the instinct is to resist. Patient's get angry or argumentative. They beg and plead. They lose control of their mouths and emotions. They accuse their doctors of incompetence or malpractice. They behave erratically and refuse to work with their doctors. These desperate attempts to resist only confirm the doctors' prejudice toward them.
If your doc seems frustrated with you say in the most genuine way you can, "I know I'm a difficult case, and I realize I'm in the wrong on this. (Take the blame even if you weren't wrong) I'm still new to needing medical help. How can I do this in a way that help you, doc?"I realize this feels like giving in to an asshole bully who has mistreated you—and in some ways it is—but if you have an illness that needs medical help and the entire medical system is against you then you might have to play along with our delusion for a while. Sorry!
Chances are if you are getting repeatedly labeled a Bad Patient there is something about your style of interaction that sets off alarms in the medical psyche. Work patiently with one doctor to cure your "Bad Patient Syndrome" and you'll likely find the doctor-handling skills you learned will work with every other MD you encounter.
What really shocked her, though, was the distinct feeling of hostility she felt from her doctors.
In desperation, she wrote Dr. D to ask, "WTF just happened?"I wish I could say that situations like this are rare, but they aren't. I've written before about Nice Patient Syndrome. Unfortunately there is also Bad Patient Syndrome, and it claims a lot more victims than the former.
"But why would doctors who chose this profession because they want to help people be suspicious?"Doctors have control over work excuses, narcotic pain medicines, and the exams that determine disability. This makes us popular targets of sleazy folks who want to get things they shouldn't. Docs get told more lies middle school teachers and probation officers. After getting burned a few times we learn to be suspicious. We even find ourselves being suspicious of patients who have nothing to gain from fooling us.
What we should do is admit that we aren't superheroes after all and confess that your situation has confounded our ability to help. From personal experience I can tell you this is really hard to do.Feeling powerless is a huge narcissistic injury to our superhero ego. It is a lot easier to accuse you of being a villainous bad patient who is unworthy of our heroics, that admit that we aren't as super as we would like to be.
What do you think?
Have you ever been the "bad patient" or been the heathcare provider who misjudged a patient?
Doctor D always loves to hear your stories and opinions in comments.
Is Healthcare A Right?
News Flash to Republicans: Socialist Medicine has been here for decades! Doesn’t it just make you feel dirty?
We're already providing free care—we’re just doing a piss-poor job of it:
Bad enough that Republicans are right to complain that our kids already owe China trillions of dollars we’ve wasted on healthcare.
Also bad enough that Democrats are right to point out that millions of uninsured are sick and dying without the care they need.
Humans are naturally self-serving and take the path of least resistance.
Most people will treat anything that’s free like it’s worthless and waste it without even thinking. Just look what we did with this planet God freely gave us!
We have the right to be free but we also have the police to arrest those who use their freedom wrongly.But nobody wants a police state and nobody wants a free medical system that is constantly saying NO.
Everyone has different values and motivations, but we all accept that money has some value. If we want universal access to medical care then it has to cost money.It doesn’t have to cost much money. In fact healthcare is best if kept inexpensive. The “free market" cost of healthcare is a huge barrier to most people’s access. But there has to be some barrier. Drop the cost to $0 and you get a tidal wave of people wasting very costly care.
Okay, Dr. D has managed to piss off both the Left and the Right!
The floor is now open to your comments. Just try and be civil with each other.
Next post Dr. D will studiously avoid politics and return to the regularly-scheduled programing on Doctor-Patient Relationships.
A reader writes:
"My doctor says I'm one of the nicest patients he's ever met. He says that really nice people always get the rare incurable diseases. How can that be?"
I'm sad to hear that your doctor thinks you are wonderful, because that means have a really scary disease.And here's the real kicker: You aren't half as nice as all the doctors and nurses who are fawning over you think. And they aren't crying for you when their eyes well with tears—they're crying for themselves.
One thing you have to realize about healthcare workers is that all of us have been traumatized, whether we admit it or not.Your average graduating medical or nursing student has seen as much death, pain, and misery as a soldier returning from a war. Most of us wouldn't admit that this affects us. In fact, we pride ourselves in not letting it get to us. "I'm a professional dammit, and telling the 3rd person this week that they've only got months to live doesn't keep me from doing my job professionally!"
If you are totally different from us then whatever awful thing is happening you to won't necessarily happen to us.I hate to admit it, but first we look for the bad in you. If you've made some shitty decisions in your life or you are rude or manipulative with us then we conclude you deserve it. "This sort of stuff happens to assholes like you—Karma, bitch!"
We'd rather admit you are better than us than to admit you're just like us.We feel safe from the fear of ending up in your shoes as long as you are absolutely different from us. "That sort of terrible thing happens to assholes and angels but not normal dudes like me!"
We are frightened by your suffering and Nice Patient Syndrome is a deeply-rooted defense mechanism that isn't going away.If you try too hard to prove you have faults you might suddenly get labeled the asshole patient that deserves this and can't die soon enough.
Dr. D loves to read your thoughts in the comments.
A lot of you who read this blog have some really scary diseases:
-Have you ever been on the receiving end of Nice Patient Syndrome?
-How did you handle it?
-What is your experience with Nice Patient Syndrome?
-Do you agree with Dr. D's theory of the condition?
You're probably wondering where the long, brilliant, and eye-opening post for this week is?
Doctor D has been blogging about the Doctor-Patient relationship for a while now. It’s sort of the thing I’m known for. I’ve usually been on the doctor side of this equation. Most of my blogging, however, is to help patients figure out the weird world of medicine.
Well, guess what? Doctor D recently found himself on the patient side of a nasty injury!
Even as Doctor D looked down and realized his leg wasn’t supposed to be that shape he said to himself, “Self, take mental notes! The readers of Doctor D’s Clinic of Doctor-Patient Relational Awesomeness will want to know about this."
1) Doctor D Is Mostly Right
Any reader of this knows that Dr. D’s insight is typically brilliant and totally useful. I found myself actually looking up posts I had written for the solid and useful advice.
But even D has a lot to learn, so from here on I shall delve into the dark secrets I could only discover when crossing the line to the patient side!
We doctors think we have difficult work. We have to slave our asses off for years in school. We are expected to be perfect and heroic while working with huge uncertainty. We try to protect your health, comfort, and life, while you patients just lay back and get taken care of!
Lying here isn't as relaxing as overworked docs think it is.
Just a few days as a hospital patient cleared my mind of any misconceptions. Abject helplessness combined with severe pain trumps everything. And helplessness is far worse than pain. Dr. D had never done anything as a doctor that caused more stress than allowing myself to be put to sleep for a major operation with a surgeon I had only spoken to for 30 seconds.
3) There Is Much More To Pain Than A Number
Doctor D has written a lot on pain scoring, so I attempted to rate my own pain as a matter of curiosity. I have a good imagination for what 10 out of 10 pain would feel like, so I gave the feeling of multiple shattered bones crunching whenever my leg moved a 7, which made it the most intense pain I’ve ever felt, but I could totally handle the excruciating acute pain.
The real surprise was realizing that duration of pain was far worse than intensity. I had a throbbing pain during my recovery that I could rate as a 4 if I’m generous, but it lasted for weeks and nearly drove me insane. Low-intensity pain that won't leave can make a person much more miserable than 10 out of 10.
4) Narcotics suck
I’ve seen a lot of nice people get addicted to opiate pain medicines. So Doctor D was the dude in the ER with a bone sticking out of his leg begging not to be given morphine. When they finally convinced me to take the narcotics I was please to discover I didn’t get any high. But what I did discover is that they made me miserable in other ways. I was groggy, nauseated, itchy, constipated, and mushy-brained whenever I had to use them.
Their efficacy varies drastically from person to person. I can say with certainty that a 400 mg Ibuprofen was significantly better for pain for me than a 10 mg Percocet, but since my Ortho wouldn’t let me use ibuprofen I was stuck with narcotics. So I then had to deal with the suspicious look when I told the doc I needed more because I had run out.
I am so happy to be off those things! As a physician, it was a bit eye opening to experience how inconsistent and imperfect our best pain medicines are. Managing the pain of a fellow human being is about as frustrating a situation as an MD can experience. I doubt my prescribing patterns will change much, but I do have a deeper appreciation for how hard it is to correctly wield the double-edged sword of pain medicines.
5) Being Disabled Can Really Crush An Ego
Regular visitors to The Clinic of Doctor-Patient Relational Awesomeness are likely aware that Doctor D has a very healthy self-esteem. 3 weeks of lying on my back absolutely helpless and unable to do anything had me at the lowest place I’ve every been. One night I—a generally tough dude—cried myself to sleep. I’m up and moving better now, but I will likely have a limp the rest of my life. My whole life I’ve been able to do everything physical I wanted to do. Now I’m one of the broken people. It’s going to take some getting used to.
I know as physician I often see people with broken and damaged bodies. It kind of annoyed me when people whined about it. “Look, we can’t fix everything, so be a grown up, get over yourself, and quit complaining!” It’s easy to feel this way when you aren’t the one with the disability. I’ve given myself that same pep talk a lot in the last two months—It doesn't work as well when I’m the one with the gimp leg. A lot of my patients have far worse problems than my leg ever was. I’m manning up to fact that my leg’s gonna hurt for decades, but I think I’ll be much more patient towards patients with severe disabilities in the future.
You can't say you wouldn't complain about it if you've never been there—it's a good thing for docs to keep in mind.
6) There Isn’t A "Sort Of Person" These Things Happen To.
Okay, I have to admit something a bit embarrassing here: We doctors sometimes think of our patients as a completely alien form of human life. It isn’t intentional. We wouldn’t even admit it out loud. It’s a weird psychological quirk that happens like a reflex.
Doctor’s see so much suffering and misery on a daily basis, and we just can’t spend all our time worrying if it will happen to us too. So we develop this mental trick: "These things won’t happen to me, because I’m not that sort of person." What sort of person? Well, the sort of person who ends up the patient with a painful or horrible condition, of course!
Unfortunately, psychological defense mechanisms are useless when the cold, harsh laws of physics apply pressure to human bones. This shit happens to everybody—even doctors. No one is the sort of person that has a debilitating injury, until it happens.
7) Some Doctors Just Can’t Be Helped
Doctor D has spent a lot of time educating you on how to deal with difficult doctors. One of the worse maladies plaguing the medical field is piss-poor communication, and Dr. D’s orthopedist has about the communication skills of a mentally-retarded clam.
There's a lot that patients can do to improve their communication with difficult doctors. I had a lot of questions, and I found myself going and reading my own posts for advice on how to get answers out of a doc with weak bedside manner.
In the end I just gave up. This dude just couldn’t communicate like a normal human being with a patient (even a patient who had an MD). I hear he’s an excellent surgeon and the fact that my leg got put back together is proof of this, but his ability to converse was just dismal.
When faced with a doctor who simply will not or cannot communicate a patient has two options: Leave or trust blindly.
Dr. D had a FUBAR leg, there was only one Orthopedist available at 1:00 am, and the ER doc said this dude was a good surgeon. So I trusted him even though he seemed mentally incapable of explaining the operation he was going to do. The gamble paid off and the leg is improving, but generally I would have to advise that you hit the road when paired with doctors incapable of communicating—especially if your doctor will need to manage your problem longer than a 2 hour surgery.
Okay, that’s my story and I’m sticking to it!
Doctor D is back to limping around the exam room with patients, and so Doctor D’s Internet Clinic of Doctor-Patient Relational Awesomeness is back too. Send in those questions and I shall keep dropping knowledge on you!
What do you think?
Any of you medical folks have similar experiences and want to add some points?
Any of you with more experience as patients wish Dr. D had picked up more from his time on your side? If so, what did I miss?
Doctor D always loves to hear your thoughts in the comments!