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The gift of a “bad patient”

Yesterday I received a call from a friend – a truly brilliant person who takes great responsibility for everything in her life.  She researches nutrition and eats only healthy foods, exercises regularly, works hard and studies to increase her value to the clients she sees at work, and seriously considers her actions in nearly every circumstance.  She had just seen a new physician, who had noted an elevated laboratory value and wanted her to start a new medication.  After extensive research of the medical literature, she came to the conclusion that the benefits of taking the medication weren’t established in people like her and that there were considerable side effects.  When she explained this to the physician, he countered with, “well, I won’t label you as a bad patient yet.”

My immediate reaction was that she should have stood up and left the room.  After all, he was being arrogant, dismissive, insecure, and clearly didn’t want to engage in a collaborative relationship.

As healthcare providers, we know a lot.  We attend school, training programs, ongoing CME, meetings, read continuously, and communicate with our colleagues in order to stay abreast of the newest developments and obtain other perspectives on our difficult cases.  We work hard to know what we know. But if we’re honest with ourselves, we will admit that there’s probably more that we don’t know.  Consider some of the things you were taught during your training that are now known to be false.  How much of what we now believe is true will be proven wrong in the future?  So why do we hold onto this illusion that we know – and are supposed to know – everything?

When a person’s life or health is at stake, it’s certainly comforting to have a sense of certainty that what we are doing is the best option – that it will work.  But do we actually know that for any given patient?  Patients often get better – or worse – in spite of what we do.  We can perform the same procedure or give the same medication to two different patients and they each have a different response.

Patients generally are very understanding of healthcare providers who explain that they are unsure – that the precise answer is unknown. I often tell my patients that I want to cringe when I think of what we used to do in treating our patients’ vein disease.  At the time, we thought it was a good idea, but we later found out it didn’t work as well as we had hoped.  I follow by saying that I hope that in another 20 years we’ll look back on what we’re doing now in the same way, because that means that we’re continuing to make progress.  Consistently, I watch them smile – they get the fact that medicine is an inexact science that is continually evolving.  They are happy to reap the benefit of the advances that have been made thus far.

How different would the interaction between my friend and her new doctor have been if he had welcomed her interest in her own health?  He might have learned something valuable from the literature she had reviewed.  He might have gained an understanding of what she values in her life, allowing him to be a more effective physician.  He might have questioned his own knowledge and belief in order to either strengthen his commitment to the plan or develop an even better one.  He certainly would have earned her trust – and that is something that is absolutely crucial in the doctor-patient relationship.

How many gifts did he throw away by not countering with something along the lines of, “You seem to be very committed to your own health. What a great patient you are!”


Author: Helane Fronek, MD

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Helane Fronek

Helane Fronek MD, FACP, FACPh initially trained in and practiced internal medicine and entered the field of phlebology, the treatment of venous disorders, in 1985. Since then, she has been an integral part of the development of this new medical specialty. As the Director of the Varicose Vein Clinic at Scripps Clinic in La Jolla, California, she provided cutting edge treatment for the entire spectrum of superficial venous disorders and conducted research on venous leg ulceration, compression therapy, and emerging therapies for varicose veins. Dr. Fronek is a past president of the American College of Phlebology, the largest medical organization devoted to vein care. Dr. Fronek was the first recipient of the American College of Phlebology’s prestigious Leadership Award and was recently honored as its Honorary Member. Board-certified in both Internal Medicine and Phlebology, she is also Assistant Clinical Professor of Medicine at UC-San Diego School of Medicine. She writes regular columns on physician coaching for both Vein Magazine and San Diego Physician magazine and is passionate about helping her clients find greater enjoyment and balance in their lives.

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