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!

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.

What Is Nice Patient Syndrome?

A reader writes:

"My doctor says I'm one of the nicest patients he's ever met. He says that really nice people always get the rare incurable diseases. How can that be?"

Oh no! You've got Nice Patient Syndrome! Your prognosis is grim!

There's only one cure: Do something horrible quick! And I'm not talking about saying a dirty word or two. It takes serious antisocial mommas-lock-up-your-babies-cause-there's-a-crazy-person-with-an-axe behavior to save you from the terrible fate of Nice Patient Syndrome!

Why would the nicest human beings end up with the worst diseases?

Ask any doctor, nurse, or therapist... We've all noticed it. The most saintly human beings any of us have met seem to be the ones that get the rare, miserable, and rapidly fatal diseases. We are all astonished at the sheer angelic goodness of these patients, and we tweet message after heartfelt message about how our patients heal our hearts than we could ever heal them.

Ever notice how this shit only happens to the nicest people?

Nice Patient Syndrome really does bring out the best in the assholish medical profession. We give hugs, we fluff pillows, we do bake sales in our spare time. Dr. D once bought a ton of medicines for a nice patient who couldn't afford them. After their untimely demise we go to the funerals of our nice patients and tell their relatives how we never met a better human being.

I'm sad to hear that your doctor thinks you are wonderful, because that means have a really scary disease.

And here's the real kicker: You aren't half as nice as all the doctors and nurses who are fawning over you think. And they aren't crying for you when their eyes well with tears—they're crying for themselves.

Mental Distortion

One thing you have to realize about healthcare workers is that all of us have been traumatized, whether we admit it or not.

Your average graduating medical or nursing student has seen as much death, pain, and misery as a soldier returning from a war. Most of us wouldn't admit that this affects us. In fact, we pride ourselves in not letting it get to us. "I'm a professional dammit, and telling the 3rd person this week that they've only got months to live doesn't keep me from doing my job professionally!"

We usually do a passable job of managing (suppressing) the emotional effects of our jobs. The first few dying or crying patients may have gotten to us, but we don't feel it anymore. We promise! Just another day at the hospital...

Many of the particular quirks of doctors and nurses are psychological defense mechanisms resulting from the mental trauma. Our experiences may turn us into jerks, but we'll turn patients with scary diagnoses into angels—either that or monsters.

Fear of Dying

Doctors and nurses cannot do our work if we're afraid, but it is anxiety-producing stuff we see every day. We are the ones that watch everyone suffer and die. We watch young and healthy people get awful diseases. We see miserable people that we just can't fix. We get the fact that everyone inevitably dies someday (and many deaths are not pretty) shoved in our face daily.

Watching strangers suffer and die actually isn't as hard as you'd think. The real mental anguish comes when we reflect that the same sort of thing will eventually happen to ourselves and the people we love dearly. Dr. D does a good job taking care of sick and dying kids, as long as he doesn't wonder if this might happen to Little D someday.

We need to find some way to think of you as different from us.

If you are totally different from us then whatever awful thing is happening you to won't necessarily happen to us.

I hate to admit it, but first we look for the bad in you. If you've made some shitty decisions in your life or you are rude or manipulative with us then we conclude you deserve it. "This sort of stuff happens to assholes like you—Karma, bitch!"

But if we don't find some reason to hate you we conclude that you must be a saint. You are too good for this wicked world! This burden was laid on you because only a truly superb human being like you could handle it.

"Look, we really need you to do this for us. You don't mind, do you dear?"

We'd rather admit you are better than us than to admit you're just like us.

We feel safe from the fear of ending up in your shoes as long as you are absolutely different from us. "That sort of terrible thing happens to assholes and angels but not normal dudes like me!"

The Complications Of Nice Patient Syndrome

There are plenty of advantages to Nice Patient Syndrome. If you are going to have an awful disease it sometimes isn't so bad to be surrounded by healthcare workers who think that they aren't worthy to be in the same room as you. Trust me, you've got it much better than the ones we conclude are assholes! We'll bend over backwards for you. You can and should milk this!

There are, however, disadvantages to being though of as the nicest patient.

• You aren't a real person to us. Your goodness we keep fawning over is a creation of our own mind.

• We tend to be paternalistic with "Nice Patient Syndrome" patients. We don't want to bother your pretty little head with the dirty details of your disease, so we just make the decisions for you.

• We expect you to handle pain bravely. All that goodness makes you more resistant to pain than mere mortals! We rave about your fortitude in the face of pain, and you want to keep our respect so you won't tell us how much you're hurting.

• When we do treat your pain we will knock your ass out! We adore you so much that if you do mention you're hurting we might Michael Jackson you by accident.

• You actually aren't what we imagine you are. We sometimes send people to meet their maker convinced they have far purer souls than they actually do. You are yourself—the good and the bad. Don't buy into our delusion!

How To Handle Your Sainthood

Rule #1: Don't try and convince us that you are a normal person. Sure, you are just trying to be humble, but insisting you have flaws is actually very threatening to us. If you are just like me then whatever scary thing that is happening to you could just as easily happen to me.

"I think the world of you Mr. Smith. That's how I keep from wetting my pants when I read your chart."

You can't change us. We are damaged goods.

We are frightened by your suffering and Nice Patient Syndrome is a deeply-rooted defense mechanism that isn't going away.

If you try too hard to prove you have faults you might suddenly get labeled the asshole patient that deserves this and can't die soon enough.

Rule #2: Accept your sainthood! Learn use your new-found powers:

• Speak clearly and directly. Your words carry a lot of weight with us, but you have to sometimes speak forcefully to overcome the narrative running in our heads of whatever we expect an angelic person would say.

• Kindly but firmly demand control of your care. This is your disease, your pain, your death! Don't let your doctors and nurses take over just because they adore you.

• Defend your fellow patients. Just like you aren't the angel we think you are, the asshole patients aren't half as bad as we think they are. "Difficult patients" are the victims of the same splitting defense mechanism that created "nice patients" like you. Don't try to convince your MD or RN your fellow patient isn't that bad—it won't work. Just remind us to show more kindness to the assholes. We'll do it if an angelic patient like you asks us.

• Ask for lots of extra ice cream. We'll keep bringing it till you get a stomach ache!

Dr. D loves to read your thoughts in the comments.

A lot of you who read this blog have some really scary diseases:
-Have you ever been on the receiving end of Nice Patient Syndrome?
-How did you handle it?

Healthcare Peeps:
-What is your experience with Nice Patient Syndrome?
-Do you agree with Dr. D's theory of the condition?

My Favorite Patient Died Today

I just got a call from one of his relatives who found my number in his wallet:

“The Dude” was one of Doctor D’s first patients. He was assigned me when I was a new doc starting out in residency.

The Dude was one of those people that we all go into medicine to “help.” He was poor, and on disability, and had never gone any further than high school. The Dude also weighed about 400 pounds and smoked 4 packs a day, and he hated taking medicine ...and it was new Doctor D’s job to “take care of him.”

Medically speaking, I never was much good for The Dude. He kept doing all the things that eventually lead to his demise. In the end though, it was he that did me immeasurable good.

He actually preferred residents to our better-trained teachers, “I love these new Baby Docs when they come each year!” he exclaimed when he met Doctor D. From then on Dr. D and the Dude were always together. The Dude had a lot of office visits and hospitalizations. He was the epitome of the “difficult patient” and D spent his first year as a doctor stressing about how to save The Dude from impending death.

But it was The Dude who won out. His infectious kindness and joy in the face of pain and illness inoculated Doctor D against the harsh medical world around us.

One day D visited The Dude in the ICU and muttered, “How am I going to save you, Dude?”

The Dude let out a gravelly, smokey chuckle, “You don’t need to save me Doctor D! You’re just nice to me and I appreciate that.”

The Dude is laid to rest

Our doctor-patient relationship evolved over our years together. I did less telling him what to do and more sitting at the feet of one of the wisest human beings I have ever known. The Dude lacked any book smarts, but I know he was brilliant. He understood how a joyful attitude can keep you alive when every textbook says you should have died years ago.

The Dude had about the most unhealthy body and physical habits you can imagine, but he had the healthiest soul of any person I have ever met. He taught Doctor D that there is so much more to life than diagnoses and treatments.

The Dude promised he would try to stay alive long enough to see me graduate from my residency. He ended up outliving his promise by years. I moved to another state after graduation, but we stayed in touch. I was no longer his doctor, but we remained friends.

I took my son Little D on a road trip when he was just a baby to meet my sage friend. It was well worth exposing the kid to a little second-hand smoke. It was like taking your child to be blessed by a living saint.

The Dude and I would write or talk on the phone every couple of months. I started this blog with The Dude in mind. I wanted to answer questions for real folks like him that didn’t give a damn about medical stuff, but found themselves stuck in doctors offices and hospitals anyway. He's the only patient I ever cared for in real life who knew about my secret identity as Doctor D. He read regularly.

We last spoke about 6 months ago. I had “Call The Dude” on my long list of things to do last month, but I never got around to it. I sure wish I’d called my jolly, smokey old friend!

It came as a shock that he's dead—which is strange considering I expected him to die at any moment for the first few years I knew him, but once you really love someone you kind of expect them to live on forever.

Now The Dude is in a place where he has no need for doctors or medicines.

Enjoy heaven, my friend! I wish I'd told you that you were the best teacher Doctor D ever had!

Saved With A Dodge

Part 4 of Straight Answers From Doctors

Doctor D has dodged some questions in his career, but he has also been on the receiving end of some non-answers and can attest to their usefulness on the patient's side of things.

How the $#@% can a doctor dodging a question help the patient?

Let me tell you a story:

Doctor D’s son Little D was born with a very rare genetic condition which required he see an expert at a big university. As a parent I can tell you that this sucks. Lady D and I did a lot of worrying about our baby.

"Daddy, I don't feel good!"

Medical people are often the worst patients. We know just enough to be really difficult. Or we just know too much, and it gets in the way of our common sense.

Doctor D had never even heard of his son's super rare disease so he read everything he could find. Unfortunately the mutation was so rare that research was almost non-existent. Doctor D read every published study on the disease an found more questions than answers.

The poor Expertologist got way too many questions from Doctor D. Some he answered. Others he totally dodged. Near the end of the appointment Doctor D asked a very specific question about a potential complication.

The Expertologist smiled and said, “Oh, I think he’ll grow up and play sports and have kids of his own some day.”

Doctor D was totally frustrated. “I’m a f*#@ing MD! Of course, I know that this mutation doesn’t affect the reproductive system or the muscles. You didn’t answer my specific question!” Yeah, I considered yelling that, but instead I smiled and left the office.

I still don’t know why the Expertologist gave me a non-answer. Maybe no one knew the answer? Maybe a full answer would have taken a long discussion of probabilities and complex research he didn’t have time for? Maybe he was just sick of this non-expert doctor who asked so many questions?

Doctor D was pissed. But on the way home Doctor D looked in the rearview mirror at his sleeping baby and realized that vague answer had been just what he needed to hear: “Chill out, Doctor D. Your kid is doing fine. He’ll be okay.”

And you know what? Little D is doing just fine.Little D:
Growing perfectly as long as his parents can refrain from killing him during his Terrible 2's

Sometimes patients don’t need factual answers. Doctor D had hundreds of questions tumbling around in his over-educated head. Expertologist could have taken all day answering every question, but the real question was “Is my kid alright?”

This brilliant Expertologist totally dodged even trying to answer my question and told me what I needed to hear, “You kid is okay.”

What do you think?

Have you ever been glad an MD dodged your question?

Do you think there is any place for this in medicine?

Doctor D always loves hearing your thoughts in the comments!

Doctor D Strikes Back!

It's time we make something very, very clear:

This is not a personal medical advice blog!

A lot of people just stumble across the "Ask An MD" name and start firing off questions before they read another word. I realize you regular D Readers are not the offenders but I have to rant at somebody, so Dr. D is going to nip this in the bud right now:

I will NEVER answer diagnosis or treatment questions online!

"Luke, I am NOT your doctor!"

This isn't that I don't love you guys. It just can't happen. I challenge you to find any MD giving personal medical advice to strangers online. Nope it isn't there!

Doctor D put this info on the "Email Dr. D" page but still a majority the letters to Doctor D basically ask: "Here are my symptoms. What should I do?"

Doctor D used to write polite replies explaining that the blog is here to answer general questions about doctors and the medical system, but I really cannot diagnose you... etc.

..but as the popularity and google rank of this blog has grown Doctor D's inbox has become congested with please-treat-me-over-the-Internet emails. Abandoning all bedside manners, Dr D has begun sending snarky rebukes to the worst offenders: "Did you read the f*cking disclaimer!?!"

But that pesky medical compassion keeps D feeling sorry for all these people sending hopeless requests for help to some random medical blog!

Could These Emails Be The Symptom Of A Real Problem?

This deluge of unanswerable questions got Doctor D thinking. These people begging for answers reveal some real issues with the medical system:

1. Sick people are desperate for answers.
2. It is way too hard to get a doctor to talk to you. It costs too much money to get in, and even then the doc is in and out in like 5 minutes!
3. Doctors are terrible at addressing what is really bothering patients.

"Houston, we have a problem."

Unfortunately, turning to some anonymous doc on a blog is not the solution to these problems.

Do you really want to risk getting an answer from an anonymous doc who can't examine you—some dude who may sleep under a bridge and just plays doctor online to meet chicks? Trust me: you don't want to do that!

And Doctor D won't risk his medical license making random guesses over email for people he's never laid eyes on. Giving you a harmful misdiagnosis over the internet would make Dr. D feel terrible, and it could be the blood in the water that sparks a feeding frenzy of lawyers and disciplinary boards.

Perhaps someday doctors will be more accessible, better communicators, and be able to treat you over the Internet, but this just isn't a reality right now.

Now you have to deal with regular screwed-up doctors working in a bizarre healthcare system. Yes, it sucks, but you really don't have many other options.

This is why Doctor D runs this blog: To help you navigate the tricky world of real doctors.

If He Can't Be My Doctor, What Use Is Doctor D?

Well, if you would even consider writing some anonymous blog for help then your doctor-patient relationship is probably on life support.

It may not be your fault (doctors suck at relationships—just ask Lady D), but you will be the one who gets hurt.

Instead of desperately emailing random bloggers on the internet for answers which will likely be wrong, why don't you learn to work on with the doctors you have in your life?

Doctor D volunteers his time as a relationship counselor for your doctor-patient relationships. D isn't going be your doctor (although, he blogs anonymously so, who knows, he might actually be your doctor?), but he just might teach you how to make your own doctor useful!

So respect D's boundaries! ...And send me some questions I can work with!

What do you think?

Currently there is no way to get answers direct from a doctor online. Getting diagnosed by a doctor miles away who can't examine you is a recipe for mistakes, BUT it would be convenient.

Would you be willing to take a risk with an online doctor? Would you forgo the ability to sue if the advice harmed you? Should the standards of doctor-patient relationships change to adopt to the wired world?

By the way, if you ever sent Dr. D a forbidden e-mail now is your chance to grovel and beg for his forgiveness!

32 Years

The winner of the contest to guess Doctor D's age:

Drumroll please...

Linda!

She correctly nailed it on the head at 32 years old. Although she loses points for suggesting that Mrs. D is a "teenyboppper" [D married a woman his own age, thank you!] she still wins the coveted Medical Mafia Mug!

Congrats to Old MD Girl for finishing as runner up with a guess of 31!

But apparently Doctor D doesn't look 32.

While looking younger than one's actual age may be the goal of maturing women, it doesn't always bode well for an MD.

Patients who don't know D usually refer to him as "that young doctor."

Often in the middle of an examination patients will stop and ask, "Doctor D, how old are you?" The don't care much about the age I tell them. The real question is, "Do you have enough experience to be taking care of me?"

"Hi, I'm your new doctor. No, really I am! Wait, where are you going?"

Actually D has had an MD at the end of his name for half a dozen years and knows his shit, but it doesn't matter when the babyface stirs up immediate distrust.

D would grow a long beard to radiate age and wisdom if Mrs. D could stand kissing it, but since she dislikes beards, Doctor D has to wear his face stubbly to keep the old ladies from asking if he would like to meet their granddaughter who is still in highschool.

Admit it. This is the doctor you hoped for, isn't it?

The fact is that everyone expects a really good doctor should be old.

Now D isn't hating on old doctors, since he plans to be one eventually, but it gets frustrating when patients give him that "Oh shit, a young doctor. I'm gonna die!" look when they first lay eyes on him.

What do you think? Does a doctor's age change your expectations about his or her competence? Do you prefer younger or older MD's to care for you?

D always loves to hear your thoughts!

PS: Linda, email me so I can send you your award!

Do Chicks Dig Doctors?

Do women find you more attractive because you have an MD?

(Hard to tell, since all women swoon in the presence of Doctor D's masculine charisma even when he isn't wearing a white coat.)

Actually though, if you go into medicine because you are looking for a sexy and glamorous life you'll likely be disappointed...

Everybody reads House Of God or watches TV medical dramas and assumes that medical folks do nothing but save lives, kick ass, and fornicate like rockstars.

Millions of bright young people sign up for medical school every year certain the opposite sex will find them irresistible with MD behind their names.

"Irresistible? You know I am! ...and I totally just banged these hot nurses."

What they find instead is exhausting, banal work that destroys personal time, and patients too sick and coworkers too beleaguered to even consider romance.

But to answer the question:

"Yes, there are women who might find a man with an MD more attractive, but it is not as cool as you might imagine."

(Sorry Dr. D can only answer from the male perspective. Perhaps a woman can tell the story of the female MD's love life in the comments?)

The Social Life

If you go around in your private life saying "Hey, nice to meet you. I'm a doctor!" the ladies will think you are trying too hard. And trying too hard is not cool.

And once people realize you are a doctor they still really won't care. Generations ago being a doctor may have meant something. Perhaps back in the day when a physician entered the room everyone was struck with reverent awe, but these days nobody really cares. Being a doctor means you might be intelligent, but you're also overworked and up to the eyeballs in student loan debt. Not so sexy!

Seducing the Silly Ones

The only place where being a doctor means much is in hospitals and clinics. In the medical environment the MD means something, and there's nothing women find more attractive than a guy who is in charge. But think about it: are intelligent, interesting women in the hospital going to be lead astray by silly teenie-bopper fantasies in which the a doctor replaces the handsome prince? Nope, only the ditsy or creepy chicks!

I don't know about you, but Doctor D isn't into silly women.

So it is a rare occurrence when a woman that you would actually be interested in is attracted to you because you are a doc. But it does happen...

The Femme Fatale:

There was once a beautiful and intelligent patient who had visited Doctor D several times. Then one day she came to D's office with a hurt knee. Doctor D was dutifully examining the knee when he couldn't help but notice that not only was this attractive patient wearing a short skirt, but she also was lacking underwear!

Now in other situations obvious signals that a beautiful person has the hots for me is at least flattering, but not at work.

Doctor D stood up, said "Excuse me," and walked out. He brought a nurse in to chaperone, and for the rest of the exam kept his eyes nowhere but the knee. The patient never returned.

Sorry to disappoint you, beautiful ladies, but at work Doctor D keeps it strictly professional!

Keeping It Professional

Apparently in years past there was a more lax attitude toward frisky behavior in the hospital. Older nurses tell stories about the 70's in which the entire hospital seems to have been one big orgy with doctors, nurses, and patients going at it like bunny rabbits. (It's hard to tell if these reports are true or just the sentimental musings of soon-to-be-senile baby boomers.)

"McDreamy, I'm just too busy with romantic entanglements to see patients right now."

Despite what you may presume from watching Grey's Anatomy such funny business is no longer tolerated in hospitals. With political correctness, sexual harassment, and lawyers circling like sharks there isn't any room for behavior that isn't totally professional.

The doctors and nurses of today may be more laid back than those of the generation before us, but when it comes to mixing business and pleasure we are downright puritanical.

So, attention to all lusty young premeds:

Becoming a doctor will not get you laid! And if it does get you laid, you might ruin your career and lose your medical license in the process.

If you want to live like a rockstar, you should probably join a band.

But don't lose hope. You can still have an exciting love life. It's just that the MD won't help.

D met the stunningly beautiful future Lady D when he was in medical school. First thing she said when she found out what he did, "Ugh, I hate doctors!"

D responded, "Really? Me too! Too bad I'm about to be one of them."

I won her despite the MD. How you like them apples!

Feel free to tell your stories and opinions in the comments.

Doctor D can't wait to hear the heart-wrenching drama of your experiences in the odd world of medical romance!

How Should I Thank My Doctor?

Believe it or not, this is the most common question that Doctor D gets in his email!

I must admit I hadn't posted a response yet because the answer seemed kind of obvious: Your parents taught you how to say "thank you" when you were a baby. It should be fairly straightforward at this stage of your life. If you are grateful to your doctor tell him or her "thanks" and doc will have a better day because of you.

But as more "How do I thank my doctor?" emails poured in I had to rethink situation. I'd been thinking from the doctor side of the equation, but from the patient perspective expressing gratitude may be more daunting.

Doctors are intimidating. We hold life and death in our hands with a god-like power! Our lives are always exciting and sexy, as anyone who watches prime-time doctor dramas can tell you. MDs are so intelligent and knowledgeable that we cannot help but act like jerks to our inferiors! We are so universally admired and appreciated that your expression of thanks had better be impressive or we will scoff at you.

As a physician, Doctor D can personally assure you that all of that is BS! We only put up that ridiculous front because it helps us handle a stressful and scary job where people expect the world of us. Trust me, doctors are normal people: we always love it when people thank us for a job well done.

I had the son of a patient find me the other day, "Doctor D, I just wanted to thank you for saving mom's life." Did I save his mom? Maybe. I just did what any doctor would have done in the situation. But thanks to his gratitude Doctor D was had a spring in his step for the rest of the day. Everybody likes to be thanked.

So if you want to thank a doctor, go for it! Say it, write it in a card, bake cookies, whatever. Trust me, your doctor will be thrilled any way you say it.

Since everyone seems to want detailed strategies Doctor D will start a series of several posts on dos and don'ts of doctor-thanking so all my readers can tap into the intricacies of thanking MDs!

You're welcome!

Did you ever try to thank a doctor and have it just flop terribly or complicate your doctor-patient relationship? Doctor D always loves to hear your stories in the comments!

Part 2: How NOT To Thank A Doctor

Part 3: Delayed Gratitude

Part 4: Thank the Doctor, Not the Chart

Part 5: Why Are Cheap Gifts The Best?

Part 6: Spreading the Love

The Cure For Doctor Addiction!

Last week Doctor D told you about the dangers of doctor addiction. Today he's going to give you a twelve (actually 5) step program to save junkies!

Doctor Junkies feel an irresistible compulsion to see an MD every time they feel any physical discomfort form their bodies, resulting in risky tests and medicines as well as financial ruin for junkies and the healthcare system. While some responsibility for the problem rests with the junkies themselves, a lot of the blame for this can be laid on doctors who can be dealers and enablers for this deadly addiction.

Doctors are aware of the junkies in their lives. If you hang out with doctors (or read their blogs) you hear them complaining about junkies hitting them up for unnecessary care. "This patient of mine called an ambulance for a stubbed toe!" We gripe about our junkies, but we don't often propose solutions to improve the system that created this problem.

Well, today Doctor D is going to change that!

Doctors must take action to stop this madness before it gets out of control!

Here is Doctor D's plan to deliver our patients from the sad bondage of addiction to unnecessary medical care and lead them to the promised land of wellness!

1) Preach the Natural Healing Power of the Body.

Here's a big secret we don't often tell patients: the human body has an almost magical power to cure itself when infected and heal itself when injured! Who knew? In fact, before modern medicine this secret self-healing power of the body was the only thing that cured sick humans, and believe-it-or-not the human race survived. Modern patients and modern doctors often forget the human body has the ability to heal itself. Doctors are trained to intervene in the rare situations when body's own self-healing fails, but before long we find ourselves intervening when the body is doing a fine job on it's own because we only thing of medical cures not the body's own self-healing.

Doctors need to be spokespeople for the body's own immune system! We should spread the word about the body's abilities. We must acknowledge that even in our "medical miracles" the body does most of the healing on its own.

If MDs preach the amazing healing ability of the body, doctor-junkies will believe their body can handle that runny nose a few days without running to a doctor.

2) Grow a Pair and Don't Piss Your Scrubs at the Mention of Lawyers!

Most docs could easily educate patients on what symptoms usually aren't serious. Heck, we could give you a handout of all the symptoms that don't require a doctors visit if they are short lived: runny noses, coughs, joint aches, low-grade fevers, diarrhea, feeling yucky, etc. We could alleviate your anxiety with one therapeutic dose of knowledge.

Why don't we?

Doctors are terrified the information we give out will be used against us by blood-sucking lawyers.

We won't tell you to stay home with that runny nose because a nasal drainage could also be a symptom of a one in a million cerebrospinal fluid leak. We get terrified of missing zebras, so we kill a lot of horses. Fear of missing a rare diagnosis drives MDs to do irrational and dangerous things. We whip up doctor-junkies into a panic over their harmless symptoms and send them like lemmings over the cliff of over-doctoring.

Medicine is about taking risks. We risk your life every time we write a prescription or order a test. We should also be willing to take a risk by not doctoring conditions that are likely benign. There is risk either way, over-treatment protects us from lawyers, so physicians kill lots of doctor-junkies every year with big work-ups that are solely done to satisfy lawyers. Since we take risks either way, then we should practice with common sense and share our reassuring knowledge that most mild symptoms aren't dangerous with patients.

If blood-sucking lawyers want to sue me for using common sense, fine! Bring it on, bitches! Doctor D is ready!

3) Believe in prevention

Proper primary care can often prevent illness or catch it before it becomes serious. Fighting disease is only a secondary goal of medicine. Preventing serious illness is the real goal of primary care.

What does this have to do with doctor-junkies?

Doctor D has noticed a pattern that the MDs that give out the most unnecessary care to doctor-junkies are the same ones that suck at keeping their patients up to date on their preventive care. Coincidence? Nope.

Dangerous Doctorphilia is a need for the reassurance of receiving medical care. Preventative care fills this need in the safest possible way. Preventative care recommendations are constantly evaluated to insure their benefits far outweigh their risks. Appropriate preventative care and regular physicals can rehabilitate a former junkie. Their body has been checked for and vaccinated against most common problems. With prevention in their lives patients can have the confidence to weather minor symptoms without running to the ER.

4) Talk About the Risks of Medical Care.

Most patients don't realize that even appropriate medical care can be dangerous. Doctor-junkies love pills, and tests, and X-rays. The more the better! I've had junkies accuse me of trying to deny them the good stuff they are due when I'm just trying to protect them. "Order more, doc. I've got insurance!" WTF?

The best time to educate patients is when we are do appropriate interventions.

Many people at some point in their lives get a serious illness that requires aggressive care. If the power modern medicine helped their serious illness, they assume the same weapon should be used on their minor symptoms.

So, Doctor D actually educates people about the risks of care when he is giving it appropriately, "Antibiotic have some very real risks and I wouldn't give them if I didn't think your infection was serious." A word like this can save a patient from the frustrating and dangerous life of a doctor-addict who will beg for antibiotics every time they get a cold.

5) Educate Fearlessly!

Ultimately the cure for doctor-addiction is education. Instead of laughing at doctor-junkies' errors MDs should show them the light. Most doctor-junkies aren't stupid or irrational, they are just misguided about the proper use of medical care. It will take time and a bit of risk for doctors to show junkies a better way, but it is worth it.

After all, they are our junkies. Who is going to help them if not for doctors?

What do you think? Do you think this plan could will stem the tide of doctor-addiction? Have you ever had a doctor educate you on the power of your immune system or the risks of medical care? Did it help you avoid unnecessary medical care later?

As always Doctor D loves to hear your thoughts in the comments!