"Can you believe that patient?" my medicine attending said to my senior resident as we were exiting her room on rounds one morning.
"I know!" replied my resident. And then mimicking the metastatic cancer patient in a high pitched nasal tone of voice, "I had a pain pump the last time I was admitted here for this."
"Total drug seeker," my attending said.
"God yes. No narcotics for her," agreed my resident.
Did you pick up on the fact that we were right outside the patient's room at this time?
The other medical student on the service and I looked at each other. What were were going to say? The patient had seemed sincere enough to us. I didn't know what exactly other than the specific information about what had been done for her pain in the past had led the attending and chief resident to believe that she was a drug seeker. But it seemed really messed up to me that they'd be talking about it the way they were in front of us the med students, and worse: in front of the patient.
Later I had a patient who *I* thought was probably narcotics seeking with this same attending. However on THIS one the attending was with the patient. I was the horrible medical student who didn't believe the patient. "You should always listen to the patient," she lectured me, "Never assume someone is drug seeking."
What struck me was how two different people can come away from a single patient encounter with completely different interpretations of the situation. And how much power one attending has to make a patient's life hell during a hospitalization.
Not to mention the unprofessional conversation outside the patient's room.
When I say that medical school made me understand why I don't like most doctors, it's examples like this that highlight why this happened.
Maybe that's why, when the Epi department was trying to get me to focus on a single disease for my PhD thesis, I kept coming back to my bad doctor stories. The appalling communication gaffes. The doctors who projected their own issues onto the patients. Who used their power to subtly punish "bad" patients by withholding services or their time.
And what was "bad" you may wonder? A "bad" patient is one doesn't fit a doctor's (or nurse's) specific idea of how a patient should behave. Who doesn't say what a patient is supposed to say. Who screams too loudly or squirms during a painful procedure. Who asks too many questions. Who requests something that the attending doesn't want to provide. Who doesn't appreciate how tired the doctor is, and how the doctor really wants to be spending time with his/her family rather than be rounding this Sunday morning. God Dammit!
Ungrateful Patients.
I saw over and over again doctors who thought they had told their patients one thing, but how anyone standing there listening could see how that communication hadn't been received the way it was intended. And how if the attending realized later that this had happened, that it was ALL THE PATIENT'S FAULT. God, if only they had listened!
I really don't like the bad doctor stories on the Well Blog. It's often clear to me that the patient just didn't get it. There are so many wacky health beliefs on that blog it sometimes truly astounds me. Angry people. At the same time my heart breaks when I read those stories sometimes. Because I know the patient got screwed by some doctor who just couldn't be bothered to listen or understand where they were coming from.
And the patient suffered the consequences.
6 Pearls of Wisdom:
This is the kind of thing that makes me cringe as a med student... I just hope it bothers me in 10 years when I'm an attending.
Just wrong.
Both sides are guilty of bad behavior at one time or another. I know I have been, too. We all screw-up.
But that doesn't mean it should be a frequent, or intentionally insulting, event.
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I agree with everything you said. And it isn't necessarily that the doctor is a bad doc, or a bad person... just not in agreement with the patient.
My daughter and I share a primary care doctor. He loves her. He hates me. She does exactly what she's told, without asking any questions. I ask questions, and have made it clear that I expect to get answers, discuss options for treatment, and receive actual test results.
I wish you could do your research on this subject.
(by the way... I have had doctors who are more than happy to do all of those things with me, and more. I love them and wish I still lived close enough to see them.)
Hey OMDG,
Have you read the book "How Doctors Think" by Jerome Groopman? A friend of mine, who is a Director of Medicine at one of our local hospitals, recommended it to me for my thesis research. I just started it today, but it looks like it tackles some of the issues you are raising.
I'm also reading Michel Foucault's "Birth of a Clinic". I don't know if you've read it, but it gives an historical perspective on how our current system of medicine came to be. Great stuff about power and control. It sounds like it would resonate with your studies.
I think that you are going to be in a position to make a difference with your work - hope you take on the bad doctor stories project.
Are you sure that the two of them aren't related to that nasty vet?
Bad doctor stories mostly boil down to a power struggle. Consider the term "non-compliance" - not nice when the patient is automatically assumed to be in the wrong.
This ought to be an interesting discussion with your advisor.
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