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?

Should Fear of Patients Keep You From Medicine?

The first of the series: Should I Become A Doctor?

A confused premed writes Doctor D for advice:

"I really want to be a doctor, but I have a fear of sick people. I don't mind needles or blood and guts, it's just people being physically sick that I am horrified by. It's the only thing holding me back from applying to Medical School. Is this something you think I can overcome?"

Excellent question my young friend!

The good news is that you aren't the only person who feels discomfort in the company of ill people. Many people feel this way to some extent or another. Ask any chronically ill person and they'll tell you how often people squirm in their presence. If you want to be a doctor you will eventually need to work comfortably around sick folks, but first lets examine why people feel this unease...

Why would you be horrified by sick people?

1) You're afraid you will catch their disease.

I suppose this is an understandable concern. But many illnesses aren't contagious and most of the others can be easily prevented with proper hand washing and immunizations. Doctor D has caught more things from his preschooler than he ever caught from patients!

But... I suppose there is always a small chance you will catch a bad illness from practicing medicine. If you aren't willing to take this risk then you should probably stay away from medical school.

2) Ill people remind you of your own frailty and mortality.

If you want to blissfully imagine you will live forever in perfect health the existence of illness in others is a painful reminder of reality. If fear of sick people is an extension of your personal dread of death then by all means stay away from medicine because every day at work will terrify you.

Believe it or not, a lot of narcissists with the this issue are drawn to medicine because they want the MD as a status symbol. They leave medical practice when they realize that the presence of suffering kills their hedonistic buzz. Good riddance!

3) Ill people make you uncomfortable because you feel their discomfort.

Human beings are social creatures. We all to some extent experience the world through the experiences of others. When we are around people who suffer—if we are at all feeling persons—we tend to feel a small amount of their pain.

This is Empathy, and empathy has motivated some truly amazing people to choose medicine as a career. Rather than avoiding the ill because of the sympathetic pain they feel, many empathic people want to help those who suffer.

If you are disturbed by ill people because you feel their pain, then you can become an understanding doctor goes the extra mile to help. We need more doctors like this.

If this is you, then you could have the makings of an excellent physician!

"Trust me kid, I'm more scared of you than you are of me!"

Disclaimer: Empathy Can Be Handicap Too!

If you feel so strongly for ill people that you turn into a puddle of ineffective mush when confronted with the suffering of another person then you aren't much use. Sick people come to doctors for help, and sympathy is an extra—a good extra, but only if it comes with professional help and skill.

Can you calm your emotions enough to think clearly and help people who are suffering greatly?

Also, empathetic doctors tend to get burned out. It's wonderful that you feel for your patients, but you have to realize that disease always wins in the end. You will lose a lot of patients. You will be unable to cure a lot of diseases. If your motivation for being in medicine is helping people's suffering you will have a lot of days you want to just give up. This is called compassion fatigue and it is the bane of kind doctors everywhere.

Can you keep doing your work with sick people and still care even when you lose again and again?

If you can maintain your empathy despite these obstacles you may just find that your initial anxiety around sick people made you into an even better doctor!

What do you think?

Patients: Would you be comfortable seeing a doctor who still sometimes feels uncomfortable around sick people? Would you go see our young premed once she graduates from medical school?

Med Students and Doctors: Have you ever overcome a dread of ill people?

PreMeds: Dr. D loves bringing premeds to the hospital and answering their questions about medicine. He always gives it to them straight about what it is really like to go through the training and then practice. So send him more questions!