May 8, 2011

How Could You Think I'm A Bad Patient?

Dr. D recently got an interesting letter from a young woman who got along well with doctors and never had significant health problems …then she got sick. She developed problematic symptoms that required that she seek a lot of medical attention.
What really shocked her, though, was the distinct feeling of hostility she felt from her doctors.
I could totally smother you with this pillow!

Her complaints were suddenly greeted with suspicion. Her report of odd pains resulted in a lecture on drug seeking. She was subtlety accused of being a lying hypochondriac and manipulating the system. When she broke down and cried at this treatment she was diagnosed with "anxiety problems." She had suddenly gone from normal healthy person to the bad patient.
In desperation, she wrote Dr. D to ask, "WTF just happened?"
I wish I could say that situations like this are rare, but they aren't. I've written before about Nice Patient Syndrome. Unfortunately there is also Bad Patient Syndrome, and it claims a lot more victims than the former.

While there some despicable patients out there, many of the victims of Bad Patient Syndrome are really nice folks who are getting the run around. The true illness is a mental one in the mind of medical people:

"The fault dear Brutus, lies not in our patients, but in ourselves!"

Why would doctors label you as being a Bad Patient?

1) We Suspect Everyone

MD's are a naturally suspicious bunch.
"But why would doctors who chose this profession because they want to help people be suspicious?"
Doctors have control over work excuses, narcotic pain medicines, and the exams that determine disability. This makes us popular targets of sleazy folks who want to get things they shouldn't. Docs get told more lies middle school teachers and probation officers. After getting burned a few times we learn to be suspicious. We even find ourselves being suspicious of patients who have nothing to gain from fooling us.

Suspicion becomes a habit of mind. Your docs are like the grizzled old detective walking out of an interrogation muttering, "His story doesn't add up. He's lying!"
Sometimes stories don't add up because people are lying, but sometimes they don't add up because the human body occasionally does strange things.

2) Pattern Recognition

It is often the patients with weird or atypical symptoms that get labeled as the bad ones. Diseases are typically diagnosed by identifying patterns of signs and symptoms. Doctors get pretty good at recognizing common patterns. It gets problematic when your symptoms don't fit any known pattern. We might look up your pattern in the books and run some tests and still come up empty handed. This is frustrating!

Learning the patterns of diseases is very useful. A majority of medical education is dedicated to learning these patterns, but sometimes the doctor's mind begins to slavishly adhere to patterns without exception. We start to think that symptoms that don't fit our patterns aren't "real" problem at all.

If your symptoms don't fit into any known patterns then you must be full of shit!

The human body, of course, is extremely complex and each person's body is unique and acts slightly differently from all others. The number of patients with signs and symptoms that don't fit known patterns shouldn't surprise us at all, but if you bring us a pattern we've never seen before we might just blame you.

3) Impotence

Doctor's hate to feel helpless. Our work gives us an incredible (almost superhuman) power to identify dieases and save lives. Like all superheros we are expected to use our powers for the good of mankind. Our patients expect us to be all-powerful and we like to feel powerful and needed.

Then you come along and we can't help. Heck, we sometimes can't even figure out what's wrong with you! Suddenly we go from feeling like superheros to pathetic loosers. Not only are you kryptonite to our superpowers, but you still expect us save you when we find all of our medical powers useless. We hate feeling this way!
What we should do is admit that we aren't superheroes after all and confess that your situation has confounded our ability to help. From personal experience I can tell you this is really hard to do.
Feeling powerless is a huge narcissistic injury to our superhero ego. It is a lot easier to accuse you of being a villainous bad patient who is unworthy of our heroics, that admit that we aren't as super as we would like to be.

4) Of Maybe You Are Just A Manipulative Asshole?

It does happen sometimes, but I believe many of our bad patients are just getting a bad rap. So if you are one of the unlucky innocent victims of Bad Patient Syndrome I am very sorry. It really does suck!

How do you overcome Bad Patient Syndrome? Well, it isn't easy, but Doctor D has some suggestions coming up in next week's post.

What do you think?

Have you ever been the "bad patient" or been the heathcare provider who misjudged a patient?

Doctor D always loves to hear your stories and opinions in comments.