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!

Doctor Shopping (Finding a Doctor: Part 3)

Okay, so you make an appointment and see your new primary doctor. Sometimes it is the perfect match. If so, excellent! But some relationships that looked great on paper just don't work out in real life and you need to keep moving. This is where things can get tricky. Physicians are very sensitive about "doctor shopping" patients, so you need to learn how to doctor shop with caution.

First, all doctors (including Doctor D) are arrogant narcissists who always think they are the best doc around. They can't understand why any patient would leave their brilliant care for a second-rate hack.

Second, if you are coming from another doctor or several previous doctors, your new doctor may look at you with suspicion. Doctors assume that those who have been promiscuous with their medical care must be unable to have meaningful relationships. The doctor might assume that you are a "difficult patient" (crazy, demanding, rude, etc.) or a "drug seeker" (addicted to prescription medicines). These are the two dirtiest names doctors call their patients. You don't want to get either label.

So you must approach first visits mindful that doctors are a sensitive, suspicious bunch. The best strategy is to let the doc know right up front you aren't committing to a serious doctor-patient relationship just yet. Say that you are playing the field and if you move on they shouldn't get their feelings hurt. If you do so in a polite way, pointing out that sometimes even the best of doctors won't work out, you should be able to leave the doctor' fragile ego intact. (Many of Doctor D's ex-girlfriends successfully implemented a similar "it's not you, it's me" exit strategy.) This way the doctor isn't upset if you leave and feels extra special if you stay.

Also on your first visit it is essential that you never tell your doctor about what jerks your previous doctors were. Your new doctor will likely assume that you did something to deserve the abuse. Never mention the name of a narcotic pain medicine you just can't live without. If you are a bit unstable try to not to show all the crazy on the first visit. Think about it like a first date. Be yourself, but be the nicest version of yourself.

Unfortunately, the primary care doctor who is stressed and overworked may not be the nicest version of him or herself at the first visit. This can be a good opportunity to see what your doctor is really like. Will the relationship work? Only you can answer that.

Even in today's depressing healthcare system there are lots of examples of really good doctor-patient relationships. So don't give up! The right primary doctor for you is out there.

Doctor D would love to hear patients' perspectives, advice, or horror stories on first doctor's visits.

Read the "How to find a Doctor" Series

Picking a Doctor (Finding a Doctor: Part 2)

Now that you have some idea what style of doctoring will work for you, it's time to actually get an appointment.

This is not Doctor D's area of expertise since he is usually on the "getting picked" end of such things, but he has tried to find doctors for enough of his own family to appreciate that this can be a tricky step. Usually you are stuck staring a a long list of unfamiliar names from the phone book or insurance company. The best way to pick a doctor is to consult the experts in your community: retirees and soccer moms.

These people know stunning amounts about every doctor in a 5o-mile radius since they spend several hours a day discussing every doctor visit they or their friends have had in the last few years. So just saunter up to an Oldsmobile or minivan and show them your list. You'll have to sit through long stories about constipation or little Johnny's ear infection but you'll hear a lot about the names on your list.

A couple things to remember about the advice you get:

• The doctoring style that worked for Harold or little Johnny may not work for you. (Like Ms. Smith from last post) Pay more attention to what they say the doctor said/did more than how they liked or disliked the doc.
• Even the best of doctors (even Doctor D) will sometimes have patients that dislike them. A complex doctor-patient relationship sometimes doesn't work even with good doctors and patients. Don't avoid a doc just because one person hates them. (But if everyone hates them don't go, unless you just want another jerk in your life.)
• Be careful when you hear effusive praise being poured on a doctor. Don't take it too seriously. Anyone who thinks their doctor is the best thing since sliced bread probably has a few screws loose. Doctor D's weirdest patients have sometimes been the ones that fell all over themselves saying he was the answer to all life's problems, when he hadn't done anything for them.

So with those things in mind circle one on your list and get an appointment. We'll talk about what to do at that appointment in Part 3.

Read the "How to find a Doctor" Series

Ms. Smith and the Doctors

So in the last post Doctor D told you about 5 different styles of doctoring, but how would these doctors care for a patient with a difficult situation?

For this I give you the hypothetical patient: Ms. Smith. Overall she is feeling well and getting all her preventive care, but Ms. Smith has one tricky problem--she smokes. It is a universally acknowledged truth that this bodes poorly for her future well-being. Even tobacco companies now admit that smoking kills. But quitting ain't easy. Ms. Smith may need a doctor to help her get there.

Which of the 5 different doctors would work best for her?

• The Drill Sergeant: "No excuses Ms. Smith, quit now! If you don't stop smoking, I'll fire you as my patient!"

• The Parent: "I understand how hard it is for you, but you really must stop. I will keep asking you till you do, because I care."

• The Buddy: "Think about quitting smoking. It would be really good for you, but if you don't want to that's okay. I'll still take care of you."

• The Consultant: "Smoking significantly increases the risk of premature death from heart disease, cancer or emphysema, as well as worsening respiratory problems and inflammatory conditions. Should you be interested in quitting I can tell you about ten different strategies for doing so."

• The Mechanic: This doctor won't actually talk to Ms. Smith about smoking. The mechanic takes as granted that smoking is just what her body does. The mechanic will provide treatments for the damage that smoking does to her heart and lungs. If Ms. Smith isn't interested in quitting, she might appreciate that the mechanic won't bother her about it.
  

Which one would work best for Ms. Smith? Well she's a fictional person, but perhaps the one you thought best for her indicates which sort of doctor you should be looking for.

More on finding a new doctor.

Types of Doctors (Finding A Doctor: Part 1)

Magda asked how to find a new doctor on this post. She likes her current Primary Care doctor but wonders what she will do when he retires. This is a big question so I'll answer it over several posts:

First, you need to figure out what style of doc you need. Every MD has his or her own style of relating to patients. Knowing what sort of doctor you would work with best will help you choose the right one for you.

Of course doctor is special like unique snowflakes etc... but Doctor D has broken it down into five basic doctoring styles he sees often. Some doctors may combine several styles. Doctors often don't really know what their style is (Doctor D isn't sure where he fits on the list) but the doctor's patients can always tell you.

Five Doctoring Styles:

1. The Drill Sergeant: Gives orders and expects absolute obedience. The drill sergeant is very confident and knows more about your body than you do. These doctors won't take any crap from you or anybody else. This meanness can come in handy since drill sergeants go ballistic on anyone who messes with their patients.

   • Pros: Some patients need no nonsense firmness to get results. If you trust doctors and need to be pushed to live healthy this doctor might work for you.
   • Cons: They tend to be abusive. Your opinions and feelings really don't matter to drill sergeants.

2. The Parent: A warm, wise parental figure who watches out for you. Parent doctors want to know how you are doing and want the best for you. Parenting style medicine is more common in older doctors. These doctors kindly guide you to the healthcare decisions that they know are best for you.

   • Pros: Parent doctors are often the nicest physicians.
   • Cons: You will likely be treated like a child. The parent doctor will often make your decisions for you.

3. The Buddy: Treats you as an equal, wants to be your friend. The Buddy doctor lets you make your own decisions and just wants to help. These doctors worry a lot about whether you like them. Buddies may give you a treatment because you want it, even if they don't think it is the best thing for you.

   • Pros: Works hard for you and treats you with respect and kindness.
   • Cons: May not give you difficult facts or ask hard questions. Sometimes passive-aggressive.

4. The Consultant: Treats your relationship as strictly professional. The consultant's role is to give you information and provide you with treatment options. You make all the decisions. The consultant is just there to answer your questions should you have any. Consultant doctors may overwhelm you with options and the pros/cons of each. They tend to be neither angry nor friendly, but always professional.

   • Pros: Informative, always professional. Consultant doctors don't get emotionally involved which means less drama.
     
   • Cons: May overwhelm you with facts and options without much guidance. As long as you are making informed decisions it's no skin off the consultant's back if you live or die.

5. The Mechanic: Sees your body as a machine that needs tune ups and repair. The mechanic doctor doesn't really recognize you as a person at all. Your medical issues are all mechanical problems to be solved. Don't expect a mechanic to talk to you much. They may speak about your body, but usually this is the doctor talking to himself in medical Latin that you probably won't understand.

   • Pros: Usually very intelligent in a scientific way. Who needs human interaction when you can have a robot doctor?
   • Cons: No real relationship. You probably won't understand a lot of what the mechanic doctor is doing for you. You could ask but the answer usually won't be in plain English.

Next Post we'll look how these doctors would work with a particular patient: Ms. Smith

Read the "How to find a Doctor" Series

How to Choose a Primary Doctor: The Series

Response to a reader question on how to find a new Primary Care Doctor:

• Types of Doctors (Part One)
  

• Ms. Smith and the Doctors (doctor types in action)

• Finding the Doctor (Part Two)
  

• Doctor Shopping (Part Three)
  

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