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Mean Patients: The Real Reason Why Physicians Are Quitting Medicine?

A "Medical Service Provider"

As I sat in my orthopedist’s exam room, the discussion quickly turned from my chief complaint to his: “I don’t know why I’m doing this anymore,” he said. “Medicine is just not what it used to be, and I don’t enjoy my work anymore. The bureaucracy and regulations are bad enough, but what really gets me is the hostility. My patients are chronically angry and mean. The only comfort I get is from talking to other doctors. Because they all feel the same way.”

Perhaps this sentiment strikes you as the spoiled musings of a physician who is lamenting his demotion from “god” to “man” – reflecting the fundamental change in the public perception of doctors that has occurred over the past ~50 years. Or maybe you wonder if this surgeon’s patients are mean because he is a bad doctor, or isn’t respectful of their time? Maybe he deserves the hostility?

I’ve found this particular surgeon to be humble, thoughtful, and thorough. He is genuinely caring and a proponent of conservative measures, truly eager to avoid surgical procedures when possible. He is exactly what one would hope for in a physician, and yet he is utterly demoralized.  Not because of the hours of daily documentation drudgery required by health insurance and government regulators, but because the very souls he has been fighting to serve have now turned on him.  Their attitudes are captured in social media feeds on every major health outlet:

Doctors? I no longer afford that kind of respect: I call them “medical services providers.” They and their families and the medical cabal created this mess when they got control of med schools so that the wealth of a nation would remain in the hands of a few medical elites and their families. The very notion that doctors are smarter, more productive, more anything than others is ludicrous. They are among the worst sluff-offs of our society, yet the richest at the same time. It is an unreal world they have created themselves and they are now watching the natural outcome of such a false system.

The very best physicians have always been motivated primarily by the satisfaction of making a difference in their patients’ lives. That drive to “help others” is what makes us believe that all the sacrifices are worth it – the years of training, the educational debt, the lack of sleep, the separation from family, the delay (and sometimes denial) of becoming a parent, the daily grind of administrative burden, the unspeakable emotional toll that death and disease take on your heart… All of that is offset by the joy of changing and saving lives. But when that joy is taken from you, what remains is despondency and burn out.

What patients need to realize is that they have been (and still are) the primary motivator of physician job satisfaction. Patients have the power to demoralize us like no one else – and they need to take that power very seriously. Because if negative attitudes prevail, and hostility spreads like a cancer in our broken system, the most caring among us will be the first to withdraw.

And in the end all that will be left is “medical service providers.”

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7 Responses to “Mean Patients: The Real Reason Why Physicians Are Quitting Medicine?”

  1. Trisha Torrey says:

    Val – you make a great point about motivations and mean patients. And I agree – this is not about falling from “god-like” status. I understand why doctors are burning out.

    But I do have to wonder what “mean” means. Patients, in the process of trying to accept responsibility for their own care decisions need options and answers. Does “mean” indicate that doctors don’t like being questioned? Does “mean” indicate that a patient feels a doctor must earn his trust instead of bestowing it automatically? Can a doctor be empathetic to the potential for bankruptcy because cost has skyrocketed – to no further advantage for the patient OR the doctor?

    Until the past few years, most doctors have operated in bubbles – providing what they wanted to provide, in the timeframe they wanted to provide it, unchecked, unquestioned by their patients, and being paid for everything they did (in some cases, whether or not it was necessary.)

    Now doctors are being held accountable for their work in some new ways. No longer are they accountable only to payers. Patients are holding them accountable, too. Patient satisfaction is now, partially, a result of feeling as if one’s doctor has been participatory, communicative, and supportive. “Drive by doctoring” isn’t OK. If I’m spending a fortune on my care, I expect to know everything there is to know about it so I can make the right decisions – for me.

    This expectation of accountability may be new, but it shouldn’t be a surprise, nor should doctors disagree with the principle. They do themselves AND their patients a favor by helping patients better understand, in 360 degree fashion, exactly what to expect.

    That will go a long way toward subtracting that “mean” label. Further, because patients will become more positive, it will go a long way toward reducing rates of burnout, too.

    Trisha Torrey
    Every Patient’s Advocate

  2. You make good points, Trisha. Mean is hard to define, but seems to be captured perfectly by the attitude expressed in the snippet I posted from another blog. Good doctors (in my opinion) have been acting accountable the whole time – expressing concern for patient costs, being kind and listening carefully, finding ways to educate and partner with their patients. Apparently there were enough “bad doctors” out there that we had to enact new rules and regulations to force them to be more accountable (instead of doing right for right’s sake). If there are new ways to make patients happier, I’m all for it… But I beg the unhappy patients not to take it out on their doctors if it’s “the system” that is getting them down.

  3. Austin Brandt says:

    100% agree that the patient quote included here is mean spirited, no matter how you define the word. No matter how we frame the argument though, an “us vs. them” viewpoint will slowly destroy both sides of the table. There are certainly examples of mean patients, there’s just plain rude people all over this world. In that same light, it’s just as easy to find examples of mean physicians. What matters is that collectively we are a care *team* and that we work together to make people healthy. Any amount of finger pointing just hinders the effectiveness of that team.

    I have the utmost respect for anyone in the medical profession. The hardships you describe in your article are so much just the tip of the iceberg it’s not even funny. And I know you, and most good doctors, have the highest respect for your patients as well. I just hope that we can resist using burnout as an explanation for declining patient care. It’s not just “the system” that’s getting the patient down after all–we’re people that are sick, confused, anxious over bills, and just plain scared. You deserve to be fulfilled in your career path given everything you have to endure, and we deserve to be healthy and happy given that we’re human beings.

    Austin Brandt

  4. Thank you for your thoughtful comment, Austin. I think that physicians are becoming “meaner” themselves over time – as sheer exhaustion and exasperation sets in, many decent docs can become ill tempered. Also, the most caring ones tend to experience the emotional toll more acutely, and may opt for part time or other work. What’s left? A higher percentage of physicians who don’t care… It’s a negative feedback loop where the less caring continue to practice, fueling the dislike and mistrust that (now based on legitimate concerns) subjects the last good ones to extra negativity. I don’t want to make it an “us vs. them” argument – just don’t know how else to explain the phenomenon I’m witnessing. Though polls might suggest that physicians are still generally liked and trusted, the reality on the ground seems different to me. I personally still get great satisfaction from my work, and that satisfaction comes almost entirely from the warmth I feel from patients and their families. I always go the extra mile for each patient, understanding how awful, confusing, expensive, and scary the system (and illness itself) can be. But I can’t do it full time. It would wreck me.

  5. Kathleen says:

    The best way around this dilemma, for doctors AND patients, is to practice in a way where doctors again work directly for patients (direct pay, or “cash” practice). Medicare is being covertly rationed by rules and payment squeeze, deductibles are going up under ACA, so that provides the opportunity to do better. If prices are posted and reasonable, and the care is excellent, people will come. People may think that doctors go “cash” to make more money, but actually they may make far less. Some of us do it for the freedom to again practice personalized, high quality medicine, and escape the bureaucratic treadmill. AND, patients who don’t like the model tend to go elsewhere. No more “entitled” attitude, but also greater patient and doctor satisfaction.

  6. Kathleen, in my experience you are exactly right. The best doctor-patient relationships I’ve seen were in a direct pay practice in Virginia. It really does solve 99% of the problem. See an example here:

  7. Sara Buscher says:

    Patients and physicians are both dissatisfied with a health care system more concerned about data capture and how much time is allotted to an appointment– and patients are taking it out on the physicians they see.

    We need to work together to change this. Patients aren’t widgets and doctors are not glorified mechanics. No amount of data fed into a computer is going to be able to render a correct diagnosis or design an appropriate treatment plan like a caring doctor.

    If you are tired of mean patients, please don’t give up. Tell them you don’t like the constraints being placed on your being able to help them and that is what you want to do. Try as you can to be a team.

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

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Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

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Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

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Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


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