FYI, patients: Docs think you can be annoying, too

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An item on lack of empathy among physicians, notably oncologists and thoracic surgeons, posted Sept. 22 on Booster Shots really struck a nerve with readers. People were annoyed with, even enraged by, their experiences with doctors. They described them as overworked, greedy, arrogant, albeit necessary. Few used words like ‘sympathetic,’ ‘compassionate’ or ‘empathic’ to describe doctors.

In fairness, there’s another side to the story, told in a 2006 Medscape General Medicine survey. The title of the survey says it all: ‘ A Survey of Neurologists on Bothersome Patient Behaviors,’ and they begin the study summary by putting it in context:

Hard as it may be to believe that charming little you could be anything but a joy to the physicians in your life, the neurologists had some suggestions for the people who come into their offices. ‘Know your meds; be honest; don’t play doctor; expect delays; and be fresh-smelling,’ the authors wrote.

Fresh-smelling? One can see how the opposite of that could be bothersome, particularly in an undressed, close-up examination setting.

‘The survey was about behaviors that can end up hurting patients,’ said Dr. Randolph W. Evans, clinical professor of neurology at the Methodist Hospital in Houston. ‘We came up with a list, kind of like a David Letterman Top 10.’

They handed out surveys at a neurological conference to 191 registrants to be filled out anonymously. The doctors rated 30 hypothetical situations for annoying-ness and frequency of occurrence. Then the responders were free to add their own five most bothersome patient behaviors.

When all the votes were tallied, these were the five worst patient behaviors:

• No-show for appointment
  
• Verbally abusive with staff
  
• Poor compliance with medications or treatment
  
• Late for appointment
  
• Do not know the medications they are taking
  

No shows or late arrivals are bad for the doctor, and all the other patients on the schedule for that day, says Evans. ‘There’s a hole in the schedule, and we’ve still got to pay the secretaries, pay the rent,’ he says. ‘One of the reasons that doctors run late is that patients run late. I’ve had people show up four hours late, or on the wrong day.’ Even though, in his practice, he says, they get a reminder phone call and/or e-mail message.

He’s had people call his office staff, after not being seen for a couple of years, demanding a refill on an old prescription. ‘For routine prescriptions, I want to see them every year. This is standard for primary care and specialties,’ he says. ‘But sometimes, people will start cursing, using four-letter words with the staff, when they don’t get the refill.’

Yes, that would be bothersome.

Physicians understand that compliance with medications or treatment can be a problem if people are short of money. Some have made a conscious decision not to take drugs because of personal philosophy. ‘And that’s fine,’ says Evans. But clue your doctor in on what you’re doing, and be honest.

One of the worst things for a doctor to confront, according to the survey, are patients who have no idea about their own medical history, or even the drugs they’re taking. ‘That’s not only infuriating, it’s dangerous,’ says Evans. ‘You run the risk of dangerous drug interactions. It’s important for a physician to know every prescription, plus alternative therapies and herbal drugs. That’s where it’s important for patients to take responsibility.’

And did anyone mention cellphones? Turn it off. Don’t take calls in the middle of an exam, or when the doctor is trying to explain your condition to you.

A few other annoyances: patients who demand drugs or tests that the doctor deems unnecessary; patients who bring in family members or friends for free advice from the doctor; patients who bring way too many children or family members into the consultation room.

And one Evans can relate to: patients who challenge recommendations based on Internet or television information the doctor believes is incorrect. ‘One time I was treating a woman who was pregnant and had headaches,’ he says. ‘I started talking about migraines during pregnancy, and her mother, who was in the room, kept contradicting everything I said. She said she had seen something on TV. Well, it turned out that was me she saw on TV. She had remembered incorrectly what I had said.’

Late-night calls are expected, the doctors acknowledged, but they should have an element of urgency if a patient is going to wake someone up. Here’s a sample of some of the phone calls the surveyed physicians got after hours or in the middle of the night:

• ‘Someone paged me and wanted to know if I was black.’
  
• ‘A woman called in the middle of the night wanting to know if a hysterectomy meant she would not be able to have any more children.’
  
• ‘A patient called to tell me his bowel movement was floating. I told him to watch it, and call me when it sinks.’
  

Yes, patients, admit it. Some of you are no great shakes, either.

It comes down to good manners on both sides. ‘Respect,’ says Evans. ‘It’s a two-way street.’

-- Susan Brink