What Gets Doctors’ Goat? Well . . . We Do
Have you ever wondered what drives doctors nuts about us patients? Awhile back, I stumbled upon some pet peeves--at least for British docs--at a physicians’ chat group. Some of the complaints, of course, are not relevant to the U.S., such as the rants I read about demands for home visits that the doctors deemed unnecessary. (“Home visits: Just say no. It worked for drugs!” wrote one wag of a doctor.)
While resistance to the practice is mounting, British doctors do still visit patients at home. I even witnessed it a few years ago. There was my mom lying flat on her back, and there was the doctor, complete with medicine bag, climbing the stairs to examine her! Thank goodness a doctor was there because . . . (gasp) . . . the shock. . . .
At the chat group (where the word “Aaaaaaarrrrgh!” came up a lot), there was also a discussion about “bloodcurdling phrases”--basically, things we patients say that make doctors shudder. Examples:
“Had to wait two days to get an appointment to see you, and now it’s got better.” (Uh-oh, I’ve done that myself.)
“So, are these going to work, then?”
“I don’t come very often, so I’ve saved up a few things.” (I’ve done that too!)
And this one: “You don’t seem to have helped me lose any weight yet.”
These British doctors weren’t just venting about patients, but also about their busy practices. Some provided helpful time-saving tips to their colleagues. “Abolish Saturday morning surgery; it [messes] up the weekend,” suggested one writer. “Practice nurse does all chronic disease management. Man, I don’t even know how to take BP [blood pressure] anymore,” offers the same doc. “I have stopped taking the BP cuff off; the patients do a much better job and then fold it neatly as well,” offered another.
And these venting doctors were clearly a testy bunch: Even innocent remarks from patients such as “How are you then, doctor?” irked some of them. (I’ll never do that again.) But let’s be charitable: I know that after a long day, it doesn’t take much to set me off either. “Hi, Rosie” has been known to do the trick.
Which leads us to ask: What drives U.S. doctors nuts? Let us know. Just don’t be too mean.
Falling Down on the Job
Speaking of annoying things patients do, I’m not even going to tell you how many years I wore my last pair of contacts before I finally got around to getting new ones. I wasn’t totally honest with my optometrist either. (Was he fooled? Do doctors and other health professionals automatically apply algorithms to figure out how many cigarettes patients really smoke or how often they really exercise?) I knew I needed new lenses--but, well, I was busy, there was never quite the time. . . . Doctors must hear stuff like this every day.
Another thing that must irk them is when patients don’t follow their advice and finish courses of antibiotics--without, that is, missing three days then bolting a handful, missing another day, etc. Or when they don’t clean up their diets. Or follow that exercise plan.
It must be especially riling when such “noncompliant” patients should know better--and they often are educated, according to a recent issue of Hippocrates magazine (a kind of coffee table mag for doctors). In a huge study of nurses, for instance, “only a scant 3% closely adhered to advice on diet and exercise,” said the article.
Compliance, the article also reported, has been an issue in medicine for ages. (Did Middle Ages doctors scribe angry letters about patients not finishing their full course of ground earthworms and hemlock juice?) And it’s been referred to in many different ways. Patients have variously been defaulters, faithless, untrustworthy, unreliable or dropout. These days, some docs think “compliance” is too paternalistic; they prefer “adherence.” But not all agree.
“Compliance seems too authoritarian, adherence seems too sticky, fidelity has too many connotations, maintenance suggests a repair crew, and self-regulation or self-management seems too liberal,” wrote one Dutch doctor. Recalcitrant? Free-spirited? Absent-minded? Busy?
I have this great thesaurus at my home that docs are welcome to consult should they be in my neighborhood. (And, doc, as long as you’re here--there’s this little dry cough I’ve had for a week. I’m sure it’s nothing. . . . Oh, yes, and a rash. And my knee is playing up again.)
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If you have an idea for a Booster Shots topic, write or e-mail Rosie Mestel at the Los Angeles Times, 202 W. 1st. St., Los Angeles, CA 90012, rosie.mestel@latimes.com.
