Patients and Doctors

Observations by Dr Peter Elias, USA (permission granted) to DC January 2016.

Over my four decades as a family physician, I have become convinced that the engaged and assertive patient is the best part of my day. I try not to be the worst part of their day.

There are some patients who never listen to family or neighbors, read an article, listen to a news story or check the Internet for information about their symptoms, diagnosis or treatment. I think I met one of them once, about 10 years ago. I don't spend time worrying about this group.

There are many patients who accumulate a considerable amount of medical information, some good and some bad, from a wide variety of sources. They may or may not tell me what they know or have heard, even if I ask. And if they are normal humans, they will not be able to accurately identify the source of most of their knowledge. This group I try to support by telling them some stuff during our visit and pointing them in the direction of good resources.

There's a small but happily growing group that believes that information is powerful, that recognizes that I am human and my time is limited, and actively educates themselves. They usually tell me, and offer me information. The overwhelming majority have become pretty good at this and tend to find good information from reliable sources, though they often express confusion about conflicts they see. They are generally grateful when I help them learn how to deal with the tsunami we call the Internet. I like to thank these patients for helping me help them.

There's a group who comes in having decided what they have or what they want, but for whom it is not cast in stone. They respond well when I listen respectfully, compliment them for having invested time and energy in prepping for the visit, and provide them with more or different information. It is rare in this group that we do not end up with a plan comfortable for both of us.

Then there's a small group of people who come in having decided what they have or what they want and nothing else will do. They don't make me angry - I am not harmed by them - but they do elicit a stress response and considerable frustration. My task is to not take it personally, to explain why I disagree, and (if applicable) why I will not accede to their request. The bias of availability makes this small group the one most clinicians are most likely to remember when this subject comes up. Most of us (clinicians) can recount a very exasperating interaction that fits this category. "A" very exasperating interaction. As in, 'last month this patient came in with insomnia and insisted on a Lyme titer because she had an uncle who had Lyme disease and stayed up late all the time.' I have no trouble remembering this outlier, but would be a fool if I judged autonomous, self-motivated, educated and engaged patients by her behavior.

I don't want to be lumped in with the jerk doctor who interrupted my patient multiple times and prescribed the medicine she had said she was allergic to. We clinicians should keep that in mind when we think about our patients.