Jun 16, 2011

What To Do If You're A "Bad Patient"

Last post Doctor D explained the sad phenomenon of "Bad Patient Syndrome" to a reader who had been branded by doctors as bad. Today in the Clinic of Dr-Patient-Relational-Awesomeness we shall teach you proven therapies for curing Bad Patient Syndrome:

The Super Simple Solution:
Find another doctor. If one doctor-patient relationship didn't work there are lots of other fish in the sea. Move on!

Knowing there are lots of fish in the sea isn't always comforting!

When the 'Super Simple Solution' doesn't work:
Some people seem to get labeled as a "bad patient" wherever they end up. Within a minute of entering the exam room the doc seems to decide that that you are gonna be trouble. Of course, some patients get this label because they really are irredeemable assholes, but most aren't. Many "Chronically Bad Patients" are just people with difficult or undiagnosable illnesses or a personality that for some reason triggers the suspicion of people with MD behind their name.

So if you are one of the unlucky innocent victims of Bad Patient Syndrome, I am sorry. It really does suck. When the simple answer doesn't work the therapy is going to be longer and harder, but it still can work...

How To Overcome Bad Patient Syndrome:

Don't confront!
If medical professionals' totally wrong impression of you is not grounded in objective reality, then you would think that exposing the falsehood would make it go away. After reading the last post you probably wanted to storm into your doctor's office and yell, "I'm not bad! In fact, I'm a great person. It's YOU who are wrong! Your own fucked-up physician brain that has unjustly labeled me! Dr. D said so on his blog!"

While I'm sure it would feel great to tell off your doctors it wouldn't help. It would likely make things worse.

Confrontation: It won't always have positive results.
Bad Patient Syndrome is a prejudice, and like most delusions prejudice is most dangerous when you try and expose it. Prejudice is subconscious. Docs don't recognize we think this way. Your confrontation or insisting on your innocence only confirms our suspicions that you must be a manipulative asshole.
If you directly attack a delusion it will only entrench itself. You have to work on it subtly until it is the prejudiced person who realizes they were wrong. Your doctor must think they discovered you aren't a bad patient on their own, without any confrontation from you at all.

Dr. D only realized he was labeling people as bad patients after he "discovered" that a few "bad patients" were amazing amazing people after all. In retrospect, I think they were quietly working against my prejudice all along.

Don't act suspicious
Okay, I admit this one is hard. Once you're labeled a bad patient everything you do is suspicious. Doctor's prejudice against you seems to find confirmation in everything you do, but this doesn't mean you have to give us ammunition.
The best way to approach this is to imagine yourself in the doctor's shoes. Ask yourself, "If I suspected someone was manipulative, dishonest, or crazy would this behavior seem to confirm my suspicion?" If the answer is YES or even MAYBE then don't do it!
When a patient suspect they're being unjustly labeled as being a bad patient the instinct is to resist. Patient's get angry or argumentative. They beg and plead. They lose control of their mouths and emotions. They accuse their doctors of incompetence or malpractice. They behave erratically and refuse to work with their doctors. These desperate attempts to resist only confirm the doctors' prejudice toward them.

Instead your strategy must be to come across as calm and above suspicion. Try to act as normal and well-adjusted with your doctor as you do with your friends and family.
If your doc seems frustrated with you say in the most genuine way you can, "I know I'm a difficult case, and I realize I'm in the wrong on this. (Take the blame even if you weren't wrong) I'm still new to needing medical help. How can I do this in a way that help you, doc?"
I realize this feels like giving in to an asshole bully who has mistreated you—and in some ways it is—but if you have an illness that needs medical help and the entire medical system is against you then you might have to play along with our delusion for a while. Sorry!

Knowledge is Power
If you have been unjustly labeled as a bad patient this may be the most important blog post you ever read. Understanding the bizarre psychology of the medical mind is of the utmost importance for you:
  • First, you can finally realize it isn't your fault: You really aren't a bad person. It really is a false label that has been attached to you by delusional physicians.
  • Second, you can understand WHY the doctor's mind becomes this way: While our prejudice against you is totally indefensible, you may realize that it is a warped product of our desire to do our jobs right and help people. Perhaps this will allow you feel sorry for us instead of angry with us.
  • Third, you can make peace with the fact doctors are out of touch with reality: It's hard to take a totally reasonable person calling you bad, but you don't mind if a crazy person calls you names because he doesn't know what he's doing. Don't assume doctors are sane just because we have letters after our names! We are subject to psychological trauma just like anyone else--and we get a lot of it in this job. It is quite possible that you are the most emotionally mature person in your doctor-patient relationship. Treat us like your grandfather with Alzheimers and play along. "Sure Jimmy Carter's the President and the KGB is trying to break into your tool shed each night."
"Don't let the white coat fool you. I'm absolutely bat-shit crazy!"

This knowledge will give you the patience and peace of mind to gradually undo the damage of Bad Patient Syndrome:

Your Long-Term Strategy
If you are stuck as the bad patient no mater where you go then stop switching MDs before you get labeled a "doctor shopper." Pick one doctor and stick with him or her. Pick a doc who seems at least slightly reasonable despite their totally misjudging you. This should usually be a primary care doctor, but if you have a chronic illness you may want a doc who specializes in your condition.

Work patiently with your doctor. Don't try to change you doctor's idea that you are a bad patient anytime soon. Your goal is to let his or her mind change on it's own. Your long-term campaign of patience, kindness, and consistency will eventually wear down your doc's prejudice.

I'm not saying this is easy. Changing anyone's misinterpretation of you is hard, and it's doubly hard when it's your doctor and you feel sick and are worried about your health.

As you work with this one doctor you will learn a lot about doctors in general. We are an odd bunch, but we are also predictable. You'll start to learn how we think: what sets off our prejudices, and also what lowers our defenses and makes us humane.
Chances are if you are getting repeatedly labeled a Bad Patient there is something about your style of interaction that sets off alarms in the medical psyche. Work patiently with one doctor to cure your "Bad Patient Syndrome" and you'll likely find the doctor-handling skills you learned will work with every other MD you encounter.

This Therapy Might Just Save Your MD Too:
Yes, you the "difficult patient" could be the one who saves an MD from becoming and eternal asshole!

Dr. D was once near burn out and lost within the delusion that patients who didn't act the way I thought they should were bad. It only took one patient who I had previously written off as a hopeless bad patient to turn me around. He was so damn genuinely nice to me that I suddenly realized I had been calling one of the most amazing human beings I would ever meet a "hopeless trainwreck."

In many ways a "bad patient" has the opportunity to transform a physician and positively affect thousands of other patients in a way a "good patient" never could.

What do you think?

Have any of you who have been labeled a bad patient every tried this?

Do you think heathcare workers are open-minded enough to reexamine their prejudice about a "bad" patient?

Dr. D always looks forward to reading your stories!