When Patients Run Out of Patience With Their Doctors

Following are stories of patients who divorced their doctors because they failed to display the qualities that patients value.

The Doctor Didn’t Seem to Know Me (or My Child)

Bessy M. Kong, a community development specialist at the Department of Housing and Urban Development, had been increasingly dissatisfied with the Northern Virginia pedxiatricians she had used for three years. The doctor or nurse practitioner was chronically late--45 minutes was typical--and the care seemed perfunctory, if competent.

One day her daughter had the flu and Kong called the office. “I left a message and then I didn’t even get a call back till the next day,” she recalled. “And then they left a message saying, ‘Make sure the infant gets lots of fluids.’ Well, Diana was not an infant--she was 5 years old. And I thought, ‘They don’t even know her.’ ”

For Kong, the breaking point occurred a few months later, when she left her downtown Washington, D.C., office early to take her daughter in for an annual checkup. “The place was packed, we waited 45 minutes as usual, and then they told me they were too busy and were going to have to reschedule my appointment,” said Kong.

“And I thought, ‘That’s it, I can’t do this anymore,’ ” she said. She marched over to the office manager to tell her why she was leaving--for good. “She was nice but she really didn’t care because they have so many people on their waiting list.

“I think it’s the attitude I really resented, that your time is worth so little compared to theirs,” said Kong, who found a nearby pediatric practice with which she is happy.

Debra L. Roter, a professor at the Johns Hopkins School of Public Health, said Kong’s experience illustrates the feeling of many patients.

“They want a personal relationship with their doctor, and that doesn’t mean social chitchat,” Roter said. But she notes that many people don’t consider waiting a long time grounds for divorce--as long as that’s the only problem.

“Waiting is a factor that people consider as they think about what they’re getting out of the relationship,” Roter said. “It’s sort of like the airlines. If the flight’s on time, people are satisfied. But if it’s late, they’ll complain about the lateness as well as the food, the flight attendants and the overcrowding.”

I Felt Rushed--and the Doctor Didn’t Listen

In January, Sandy Watson, a 39-year-old marketing consultant who lives in Montgomery County, Md., went to see her internist for tendinitis. She hadn’t seen her doctor for a while and also wanted to ask about a few other sensitive issues.

Watson said the doctor “quickly examined my elbow, declared I had tendinitis and started writing a prescription. Then she said, ‘What else?’ and I asked for a refill of a medication and she began scribbling out a prescription and said, ‘What else?’

“I managed to work up the courage to ask one of my sensitive questions and got a quick answer followed by a curt ‘What else?’ ” Watson then summoned her courage and asked about another sensitive subject: a weight-loss drug.

“She coldly told me she didn’t really believe in them and then began scribbling out a prescription anyway, and then she left the room,” Watson said. “I felt totally humiliated by the whole experience, but by the time I reached the lobby, my embarrassment turned to complete anger. So I went back to the office and I walked back into the examining room.

“She walked by and saw me and was kind of surprised, and I said, ‘Please come inside.’ And I said, ‘I have to tell you I’m extremely angry,’ and she said, ‘Uh-huh,’ and I said, ‘I feel like I’m an interruption between your other patients,’ and she said, ‘Uh-huh,’ and I told her that if I’d been treated this way in a Radio Shack, I would have asked to speak to the manager.

“And then she turned to me and said, ‘Well, I’m sorry you’re having such a bad day,’ ” recalled Watson, who found that assertion especially galling because “up until my appointment I had been having a terrific day.”

“Obviously nothing I said managed to get through,” Watson said, “and I realized I was never coming back.” She said she got into her car and burst into tears.

Eric Amo-Gottfried dumped an internist he’d been seeing for several years for similar reasons. “Every time I went in, it was as though I was bothering the guy,” he said. “I never felt welcome and he always seemed rushed. I figure I’m the consumer, and if I feel rushed and like the doctor doesn’t want to be bothered, I’ll find someone else.”

Those feelings--of being rushed and disparaged--are strong predictors of divorce by patients, experts say. The time pressures under which physicians must operate are undeniable, and there is no dispute that doctors are expected to do more now in a routine visit than they did as recently as five years ago. That change, coupled with the demands of managed-care plans, means that many doctors are seeing more patients and working longer hours.

“We have to talk about seat belts, domestic violence and guns in the house, we’re much more aggressive about treating diabetes, screening for high cholesterol and colon cancer, and all these things take time,” said internist David Gullen, chairman of the board of regents of the American College of Physicians-American Society of Internal Medicine. “Then on top of that, we might have to deal with ginkgo or glucosamine,” he said, referring to two popular dietary supplements.

When patients complain they feel rushed, it may be a reaction to the physician’s style, said Mack Lipkin Jr., director of primary care at the New York University School of Medicine.

“There are some doctors who can make patients feel that they’re the center of attention even though the visits are short,” he said. “And there are other doctors who are restless, answer the phone, interrupt, and are disinterested or just unfriendly.”

Vaughn Keller, associate director of the Bayer Institute for Health Care Communication, a nonprofit group that sponsors workshops for physicians, said that sometimes the feeling of being rushed may reflect a more pervasive problem than a doctor who sees too many patients in too little time. “Some physicians don’t have basic social skills,” he observed. “There is frequently almost an objectification of what they have learned. They just don’t have a real curiosity about people.”

The Staff Was Awful

Nikki Trahan of Silver Spring, Md., said her problem was not the doctor whom she had seen since she was 13, but the way he ran his practice.

“He was our family doctor, but my mom always used to complain about how rude the staff was,” recalled Trahan, a 25-year-old administrative assistant for a government contractor.

When she was growing up, Trahan said, the doctor divided his time between two suburban offices. Now, she said, he participates in dozens of health plans and shuttles among four offices; his staff never seemed to know where he was on a particular day. Trahan said that in order to see him, she had to call each office, trying to track his whereabouts and nail down an appointment.

“I thought he was a really great guy, but his business practices were awful,” Trahan said. “Most of the time I would be really persistent and just find him.” One day last year, she awoke with a raging fever and severe pain from a bad case of tonsillitis. “I could barely talk but I called the office where I usually started. And I was told quite coldly that he would not be in the office that day. I asked [the receptionist] if there was anyone else I could see and she said everyone was booked. I started crying and told her I was in a lot of pain and had an extremely high temperature and wasn’t there anything they could do to help me?

“And she said, ‘If I made an appointment with everybody that called here crying, I might as well throw away the appointment book,’ ” Trahan recalled. Stunned, she hung up and called the second office, and was told that the doctor wasn’t there and that the next appointment was a month away.

In desperation Trahan phoned her best friend from high school, whose uncle is an otolaryngologist at Howard University Hospital. He arranged for her to see a colleague that day. She never went back to her old doctor.

A few months later, Trahan said, she bumped into her former physician in a mall. He said he hadn’t seen her and she told him why. “He apologized but he seemed indifferent. And I know that those people are still working for him because my mother left his practice after a similar experience dealing with an emergency with my little brother,” she said.

Leslie Welch, an Internet marketing specialist who lives in suburban Virginia, had a similar experience. During a business trip several years ago, she received emergency treatment for a bleeding ulcer and was told to see her physician when she got home. But when she called her internist for an appointment, she was told she couldn’t see him for a week.

Welch decided she couldn’t wait and called a friend, who gave her the name of her physician; he saw her the same day.

“I was so peeved that I marched over to [the internist’s] office, which was across the street, and demanded my records,” she recalled. “The waiting room was packed with people, as usual,” and as the conversation escalated, the doctor came out and asked what was wrong.

“I told him his office staff was terrible and that there were too many patients,” she recalled. “And he said, ‘Well, we’ve got high overhead,’ and I said, ‘You know, that’s crap.’ I think doctors set the tone for how the office staff is going to treat you.”

Bad staff “can kill you,” said Gullen, of the American College of Physicians, who is one of several internists in a group practice in Phoenix. “I know I’ve lost patients because of it. We’ve replaced people who haven’t treated patients the way we would like. The office staff is really an extension of us.”

To Gullen, patients’ complaints underscore the contemporary challenges of practicing medicine. “The blessing and the curse of medicine these days is that you can’t just be a good scientist and you can’t just be a good psychologist,” he said. “You have to do it all.”