Bioethics Discussion Blog: "How come this doc barges in right when I'm still changing my clothes?": Challenging the Physician

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Monday, January 07, 2008

"How come this doc barges in right when I'm still changing my clothes?": Challenging the Physician

If you read so many of the treads on this blog, you will find visitors expressing to us readers all their various trials and tribulations, concerns and upsets with their doctors and the doctor’s behaviors. But unfortunately, in many cases, the visitors admit they did not communicate their concerns to the doctor about whom they are complaining. I feel it is generally unfortunate that these patients did not take that action.

I presented this issue to a bioethics listserv and a lady ethicist wrote back two examples of the basis for challenging one’s physician: “This dang doc is always an hour late, and I'm tired of having to pay the baby sitter extra just because of this guy” and “"How come this doc barges in right when I'm still changing my clothes?"

I would like to have discussed on this thread my visitor’s views of whether or not doctors should be personally and directly challenged regarding what they say or their behavior. What are the pros and cons of such a challenge of one’s own physician?
What are the benefits and what are the risks to speaking up to the doctor? Simply ventilating to a discussion blog is one thing but wouldn’t it be more constructive toward mitigation of the concern to speak up to the very person who is creating that concern? Any suggestions about how a patient should communicate their dissatisfaction to their doctor? And perhaps, one of the reasons patients don't "speak up" is the "up" part.. an inequality in power. Lets hear about that too.

Relative to this discussion would be the opposite issue: Should physicians feel free to challenge their patients to explain and perhaps modify the patient’s behavior which the physician finds unwelcome or inappropriate?

If my visitors give examples, in either case, no names please. ..Maurice.

6 Comments:

At Monday, January 07, 2008 4:38:00 PM, Anonymous Anonymous said...

I'm not sure it is worth "speaking up" after a recent experience with a doctor who clearly does not value my time. Just before Christmas I had an appointment with a specialist in a two-tier healthcare system; I have been using the public tier. I was not seen until two and a half hours past my appointment time (despite the fact that they had my phone number, an admin person and plenty of knowledge they were going to be late). During that time I sat in a freezing waiting room. When the doctor did not apologise as he took me into the consulting room, I complained and he told me that "they had one person out sick and the clinic was very busy and he was late because he had been attending an emergency". When I said I understood that, but would have appreciated a phone call to let me know they were running late, or at least an indication when I arrived of how late they were running (it was an evening appointment, and I could have gone an eaten dinner), he told me that if I didn't like how they did things, I could seek alternative care (which I may very well do, though I am concerned that my irritation at waiting so long may leave me labelled a "difficult" patient).

Part of the reason for this may be that I am "just" a public patient, but the clinic is paid for my visit nonetheless. I chose this specific practice because I was told by a doctor friend of mine that they are excellent, and very good with patients, but I disagree that any practice which has such disregard for its patients' time (which amounts to basic disrespect) is "excellent".

Sorry, this comment has been somewhat rambling but in the end "speaking up" was a complete waste of breath in this case, and in fact left me feeling worse. Short of sending the clinic a bill for my time, I don't know what else I could have done in this case to achieve a better outcome.

-- PG

 
At Tuesday, January 08, 2008 11:41:00 AM, Anonymous befuddled patient said...

This is in part to Anon (4:38) who
thought she was disrespected
because she was on public
assistance. I'll preface my story
by saying I have private health
insurance, said by some to be a
cadillac policy.

My story starts 1 week after major
abdominal surgery where I had an
appointment with my surgeon to have my staples removed.
Aside from the fact that I was kept
waiting 2 hours, to my surprise someone else entered my exam room for the appointment. No knock, the door swings open with a young
doctor rushing in with coffee cup
in hand trailed by 5 young people
in white coats. A brief unintelligible introduction, then he ordered me on the exam table, pulled up my gown completely exposing me and proceded to remove
the staples giving a blow by blow
to the young people who had gathered around me. He brusquely left with the young people in tow, leaving me to pull down my gown.
No explanation why my surgeon wasn't there (he was out of town)
why I was kept waiting 2 hours(overbooking) or what his
hospital status was (resident) or
who the young people were
(students).

This is the first time I was disrespected in a medical setting. The realization
didn't come right away. I went
home that day with my head spinning about why I was so angry.
Was I being unreasonable? immature? My surgery went well, what's my problem? Am I making
a mountain out of a molehill. It wasn't until the next day that I went over the events step by step.
It just wasn't right.

When I did see my surgeon again
sometime later I wanted to say
something, but I was afraid.
Afraid I would get a lecture that
in teaching hospitals patients are
exposed to students; modesty has to be left at the door; emergencies come up that cause appointment delays; or worse, if I was unhappy I could go elsewhere. Would this learned man
accept criticism from ME? After all, shouldn't I just be grateful
that my operation was a success?

To this day I still struggle with
my feelings over this incident. It ranges from bristling like
it just happened, to chastising
myself for not letting go.

 
At Tuesday, January 08, 2008 10:03:00 PM, Blogger MY OWN WOMAN... said...

I've never had a problem voicing my opinion or displeasure to my doctor. I wait in his office sometimes for 2 hours past my appointment but when I get into the exam room, he makes me feel like "I'm his only patient." He doesn't rush and he gets all the info he wants and needs. He always knocks before entering and always asks me about my family and how life is going for me. He makes me feel special just as he makes all of his other patients feel special. Now, do I wish I didn't have to wait so long? Of course I do, but it's the price I pay for good quality care. I guess each person has to make up their own mind what they are willing to do or not do when it comes to their doctor.

The only problem I have with him....he doesn't call the ER back promptly and he gets behind signing his charts.....and yes, I tell him about it!

Of course, you can always go to the ER (like many do) and sit for hours on end; but then, they get to yell, rant and rave in the ER, something most doctors offices won't allow.

 
At Wednesday, January 09, 2008 9:07:00 AM, Anonymous dancing with the devil in the pale moonlight said...

I could fill a book with examples of patient experiences in which I felt disrespected.

- A decision to delay a necessary surgery, made behind my back, without my involvement, without even informing me that the surgery was being delayed for two months.

- Being told at the post-surgery visit that the nurse was busy and that I should remove my own surgical dressings. My right arm was encased in a splint from my elbows to my fingertips (I'm right-handed). I was left sitting alone in the exam room, trying to clumsily unwrap yards of bandages and wads of bloody gauze. I didn't even know where to put all this stuff - wastebasket? exam table?

- Being told by a physician that I couldn't have post-cancer CT scans. In spite of the fact that my followup protocol called for a CT scan every three months for the first two years, and the instructions from the oncologist were crystal-clear. When I tried to explain this to the doctor, he gave me a pompous little lecture about how CT scans cost money and I can't keep having them.

My experience is that complaining - even politely - is a waste of time.

There is always some excuse or rationalization as to why a patient might have a bad experience. Don't want to remove your own surgical dressings? Well, too bad, but we're really busy and we have other patients who are more important than you. The patient ends up feeling blamed or trivialized, regardless of how legitimate their complaint might be.

It is fatally easy to get a reputation as a whiner. Often there is no way of knowing ahead of time how a physician or his/her staff will react when a patient expresses a complaint. So you run a risk whenever you decide to speak up about something, and many people will remain silent rather than take this risk. And even if the physician genuinely wants to keep the patients happy, there is no guarantee that the nurse or the office staff feels the same. There are all kinds of subtle ways they can retaliate, and patients know they are at the staff's mercy.

Patients are often in the dark as to how their physician clinic handles complaints. Should they speak to the physician? Should they speak to someone on the staff? Should they contact the medical director? Should this be done in person, or over the phone, or in writing? It can be even harder to know how a specific problem should be addressed - a medical injury, for instance, vs. an over-long wait in the waiting room. And what do you do when the physician himself is the problem??

My perception is that even when you complain, it might not make a difference or change anyone's behavior. People always complain about lengthy waiting times; what are physicians doing about it? Are they encouraging people to call ahead and find out if the physician is running behind schedule? Do they hand out beepers so patients can go have a cup of coffee while they wait? Do they have a decent stock of magazines and videos in the waiting room so people can have something to do while they wait? There are things physicians can do to make the waiting somewhat less onerous; are they looking for solutions or are they bashing patients for not understanding the clinic's time constraints?

Really major stuff, such as medical injury or substandard care, might earn you a response - but again, there often is no way of knowing whether it led to any change. I did write a letter of complaint about the physician who wouldn't do my post-cancer scans and wouldn't contact the oncologist to clarify the protocol. I received a polite response saying they would review my case. That was it. To this day I still don't know if this was a simple miscommunication, if I completely misunderstood the oncologist's instructions to me, if there was some legitimate clinical reason why I didn't need the CT scans, or if this was indeed a valid complaint and some changes were made to the process so it doesn't happen again.

In an ideal world:
Clinics and hospitals would be open to hearing patients' concerns and complaints. They would communicate this to their patients and create minimal barriers for patients to register their concerns.
There would be some commitment to changing processes and behaviors (within reason) that patients identify as concerns.
When major issues arise, there would be some commitment to following up and ensuring the patient is kept in the loop.

I'm sorry this is so long, but this issue really pushes my buttons.

 
At Wednesday, January 09, 2008 11:17:00 AM, Blogger Maurice Bernstein, M.D. said...

As I have stated elsewhere on this blog, my philosophy when I am in a doctor-patient relationship with my patient is: "I know things the patient doesn't know. The patient knows things that I don't know. We must be considerate of each other as we deal with each other and we must all get along together to meet each other's goals." I think that doctors should be the more tolerant party with respect to a patient's request or behavior since the patient is clearly the medically vulnerable party. ..Maurice.

 
At Sunday, January 13, 2008 6:03:00 PM, Anonymous Anonymous said...

That's outrageous that this would happen. How about after being barged in on you follow the doctor into the bathroom and see what happens. I bet then they would think twice.

 

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