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Top 10 Ways Doctors Annoy Patients

Someone suggested I was being mean or making fun of patients in my previous post. Those of you who read this blog regularly (aside from needing serious psychiatric evaluation) are aware that I am quite sympathetic of my patients’ position in this relationship.  Mine is a position of power, while they are coming to me with an admission of weakness.  There is no doubt that I would rather sit in the doctor’s chair than that of the patient – and that’s not just because my chair has wheels on it.

My intent in writing this blog is to show the doctor/patient interaction through the eyes of a physician – a perspective most people don’t get very often.  Even though I have lots to be thankful for in my profession, I still have things that regularly annoy me.  For me to voice that annoyance in a light manner is meant to both educate people of my perspective, and entertain those who share it.

Enough of that.  Now it’s time to move on to the strategies we physicians use to get back at patients for their shenanigans.  You may not realize it, but we have a special class in medical school dedicated solely to the ways to annoy and embarrass our patients.  It’s an art, really.

Here’s my list:

1.  Require ridiculous paperwork

At every visit, a patient should be required to fill out paperwork that captures information that they have provided at every previous visit.  Certainly it makes sense to ask if a person has changed insurance since the last visit, and wanting an updated medication and allergy list is good practice.  The true art, though, is in asking questions like: “Has your mother’s maiden name changed since your last visit?” or “Please list all medications (including over-the-counter) that you have taken over the last 3 years?”

2.  Waiting Room Lottery

Being called from the waiting room to the exam room should not depend on when each person arrived; it should be totally random.  Few things frustrate as much as seeing someone who clearly came in after you get called back before you.  It is quite fun to watch the reactions of people when others are called before they are.  Many office staffs take bets on who will be the first to erupt.

3.  Use a complicated and unreliable voicemail system

It is unacceptable for people to be able to actually talk to humans unless they have spent a minimum of 15 minutes meandering through the voicemail system.  The reason for this are as follows:

  1. It weeds out people who aren’t all that sick as well as those who are not going to be dedicated patients.
  2. It increases the volume of patients coming in with high blood pressure and ulcers.
  3. It creates a convenient scape goat if anything goes wrong.  ”Dang.  It must be our lousy voicemail system again…”

4.  Have unreasonable rules

Patients who are more than 30 seconds late for their appointment must be made to reschedule, and that appointment should be a minimum of two weeks after the missed appointment.  We only hope that patients don’t notice it when we are 45 minutes late to see them….  Charging $10 per page for people to get their own records is another way to create fury.  It’s good fun.

5.  Use the scale strategically

The scale in a doctor’s office is a powerful weapon that should be wielded with skill.  Many patients are as nervous to stand on the scale as they are coming to the doctor in the first place.  Increasing weight should always lead to a lecture about the dangers of obesity, and the weight on the scale should always be set to read at least 10 pounds more than is accurate.  Having the scale in a public place or having a staff member with a very loud voice can increase the trauma the scale can inflict.  Always check blood pressure immediately after weighing the patient, as the inevitable high reading can give extra fodder for lectures on the dangers of obesity.

6. Lecture

“Do you realize smoking is bad for you?”  That is one of my all-time favorites.  It assumes that the patient has missed the news about cigarettes not being a fountain of youth.  Perhaps they haven’t discovered that newfangled invention called television.  But lectures about the dangers of cigarette smoking, heavy drinking, or poor eating habits should not happen once – most patients expect that to happen;  they should be given every visit, even the ones that have nothing to do with these vices.  Have a foot fungus?  Expect a lecture about not exercising.

7.  Look frazzled

Some doctors are masters at always entering a room looking harried and rushed, which makes the patient feel guilty about burdening the doctor any more.  It really is bothersome for these patients to come with so many problems.  Giving a pained expression when the person starts talking about things is sure to shorten the visit.  So what if they are paying to be seen, the doctor is having a bad day and they should be nice to him!

8.  Don’t explain much

Prescribing medications or ordering numerous tests is part of the job.  We are paid to make all the decisions and patients should trust us!  Why should we have to explain to our patients why they should take the medication we give?  Why should they know the purpose of having a cholesterol rechecked every 3 months?  Leaving patients a little unsure about why tests are ordered will keep them from asking those pesky questions about interpretation.  Just tell them that “it looks fine” and that should be enough.

9.  Tell them there is “nothing wrong”

The baby was up all night screaming with a temperature up to 103.  Yet when they come into the office, the child looks fine and is sleeping…like a baby.  The best response from the doctor is to look at the parent with a “Why did you bring a healthy child in to see me?  Why are you wasting my valuable time?” expression.  Look the child over and declare the child healthy.  The fever and screaming are probably things the parents just made up to get attention; either that or they were hallucinating.

10.  Always somehow relate their condition to a mental health issue

Relating all problems to depression or “stress” is a great way to put patients in a difficult position.  Assuming it before any tests are run is even better.  ”I know how hard things have been for you over the past few months” is a good way to get things going.  The chest pain is probably hysteria of some sort and a good prescription of Zoloft will clearly make things get better.  This allows everything the patient says to be taken lightly, as it all represents part of their defense mechanisms in dealing with their mental problem.

—————————

This was actually a little harder to write than I expected.  I didn’t want to sound too harsh or cynical, but it kept coming out that way.  I am sure many people will have more to add.  I really do think there is a long legacy of doctors being in charge of the relationship and so abusing their status to patronize patients.  Thankfully, this is a legacy of the past and is hopefully becoming less common.  I do still, however, hear things that doctors do that make me wince with a disturbing frequency.

For all of the idiot doctors out there I offer my deepest apologies.  Don’t take it.  Leave them and put them out of business if they don’t clean up their act.

*This blog post was originally published at Musings of a Distractible Mind*


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2 Responses to “Top 10 Ways Doctors Annoy Patients”

  1. Judi Petty says:

    Another way a doctor has MORE than annoyed me:

    Pulmonologist at major teaching university/hospital disregarded my reumatologist’s request to rule out sarcoidosis. He said I wouldn’t have that…I was white and statistics were that blacks got it more often. A bronchoscopy-biopsy was performed while I was completely awake. It was quite miserable, to say the least. I was told to come back for the results in a month.

    Upon returning to get the results, the doctor walked in as he usually did, paying 99% of his attention to his handheld computer. He mumbled hi, then plainly stated “At this point, I believe we are going to have to do something far more invasive.”

    I looked at my husband and then back at the doc and said “Like what!?!”

    While never looking up from the handheld device, he stated “We need to do a bronchoscopy/biopsy.”

    Looking at my husband again and being very irritated, I said “Like the one we did last month!?!”

    Only then did he look up at me, eyes wide while asking “We already one?”

    I did not go back. He was FIRED.

  2. Judi Petty says:

    Correction on my comment – toward the end of it, I was meaning to say that he asked “We already did one?” Phew. I’m surprised I did not mess up conveying my irritation even more than that!

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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.

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Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

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.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

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“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

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.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

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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