Mean Patients Get Worse Care

So Tom and I were just having a debate, I read this article in some local newspaper about how really nasty patients, in other words patients who behave like complete assholes, when they go to see medical providers, get worse care.

So there’s some studies that show that when you have a patient that is questioning your competence, that is rude to your staff, is up in arms about the wait, whatever it is, just being what we call in the business, an asshole, that doctors, who are human beings, despite popular wisdom, they are human beings with human flaws, have to spend enough processor cycles in their mind dealing with the crazy behavior and the defensiveness that they’re feeling, that they actually start to make errors, so that patient gets worse care.

They’re labeled as a difficult patient, it goes in the chart sometimes in different code words, we all know those of us in medicine that we’ve labeled these difficult patients, whether they have a personality disorder or they’re just a fucking asshole to people, which we’re all guilty of time to time, they get worse care. And so the article was saying, well don’t be an asshole, and be thoughtful and respectful, if you’re gonna bring in a bunch of articles from the internet to your doctor, phrase it appropriately, say, “You know what, I have these articles, “they’re making me nervous. “I’m just curious what you think about this, “I’m treating this a business meeting “and you’re the expert.” But let’s be honest, and Tom brought this up, no one’s gonna do that, you’re not gonna change human behavior overnight, you’re not gonna turn an asshole into someone who’s sprouting fucking unicorn flowers out of their ass and being nice and all that, okay?

So all we can do, on the healthcare side, is realize that the problem here is not with us unless we make it our problem. So we have to look at that patient and have something, not empathy, empathy is feeling that person’s anger and whatever it is that’s driving them to be an asshole, don’t do that, have rational compassion and go, “You know what, there’s suffering here, “it’s gonna extend to my staff in this facility “and to me if I let it, let’s do the best we can “with a difficult situation and not make it personal”, that’s hard, that takes practice, but you know what? You went to fucking school for years, and years, and years to do shit, that’s harder than that.

So at the minimum, we on the healthcare side, have to learn to handle those patients, many of us are very good at it, many of us are terrible at it. I used to be horrible, I used to get triggered, I would go home, I would stew, I wouldn’t sleep, I would think about all the things I should have said to that piece of shit, and then I remember, I took a Hippocratic Oath to do no harm, and then I realized I’m a human being, I get pissed off too, right? So the answer is, listen, if you’re a patient and you’re being an asshole, if you think that’s gonna get you better care, the opposite is most likely true unless your doctor, or nurse practitioner, or PA is woke as fuck, if they’re not, and there are very few, you’re gonna get worse care. Now here’s the other secret that many people don’t know, there’s a saying among doctors when we tell each other about patients, when we do sign-out, we go, “Oh yeah, Mrs. Smith, oh my gosh, she is so sweet, “she’s the sweetest lady in the world, “such a wonderful family, they brought food, “they’re so nice, they never question anything, “they do everything we say, she’s gonna die”, literally, the nicest patients don’t do well either, because the meek don’t do well in healthcare because the system is so fucked up that if you let it, it will fuck you.

It will walk right over you, you won’t be heard, you won’t be listened to and you will die or be ill, because you didn’t advocate for yourself. So the answer to, what do I do as a patient is, don’t roll over, be an advocate for yourself, and it’s easier than done, but you know what, go in and understand that doctors are human, they have expertise, they know a lot of stuff, but at the same time they’re busy, they only have so much processor, so come in with a short list of questions, if you have stuff from the internet, you can ask, “What do you think about this, it’s making me nervous”, be respectful, but also assertive, and here’s the one liner, be a squeaky wheel that doesn’t need that much grease. And if you can do that you’ll at least survive in a system that is very dysfunctional, and if the caregiver side of it can actually step up and become more compassionate, a little more patient, maybe practice some of the shit that they try to force on us like mindfulness and compassion meditation and stuff, that can actually help a lot, it’s helped me, I am 70% less of an asshole and less reactive than I used to be, and that’s saying a lot ’cause I am a pretty big asshole. So all that being said, if there’s a take away here, okay, don’t be too meek, advocate for yourself, don’t be an asshole and learn, as a doctor anyways, to be more patient and if this helps even one person then we did a good thing, and I’m glad me and and Tom are fucking with… Tom, what do you think? I mean, anything we’re missing here?

– [Tom] I’m gonna advocate for myself, I want Percocet, you’re a doctor, you’re my friend, give ’em to me.

– Percocet, Molly Percocet , see, it works.

– [Tom] Can I get that script or–

– I’m on it, I just call in my, pharmacist. I don’t have a pharmacist because they’re all commodities now, because we fucked pharmacy up too . Smoke ’em if you got ’em.