Oct 30 2007

Doctors Complain About Complaints

… and I don’t blame (some of ) them.

I’ve seen several articles in the past few days about this topic — that doctors are feeling bashed and unappreciated.

Texas physicians blast anonymous complaints

Closer look irks doctors

Some doctors have their patients complaining on their behalf.

I’m even seeing this about doctors who are overseas — yes — where universal / national healthcare works: Top doc vows to clear name after witch hunt

There is nothing new about doctors getting upset at the fact that patient consumers finally have a public voice (through the internet) that helps vent their frustrations. Nor is it news that doctors don’t like lawsuits when they’ve committed errors. In fact, there used to be a website called www.doctorsknow.us that was established specifically to help doctors blacklist patients who they thought were too difficult. The website was taken down a few years ago, and it’s very interesting to read the comments made by doctors who were supporters.

[And, in fairness, this is not true for all doctors…. nor is it true for all patients. The takeaway here should not be doctors as a whole group — instead it should be only about those doctors who complain about their patients. ]

So we have patients complaining about doctors, and doctors complaining about patients and everyone complaining about the costs of healthcare, and the dysfunction of the “system.”

Yup – turns out this is another blamers and fixers discussion.

My observation: most complaints are rooted in mismanaged expectations that regard communications and the time/money conundrum.

Do you know of anybody who is happy with healthcare these days? Even if you have a dread disease, and get cured, you’ll complain about the cost, right?

Patients no longer “need” a medical error to get upset. The complaints I hear are that the doctor won’t spend enough time with them, or doesn’t answer all their questions, or always seems in a hurry.

Doctors are frustrated that their patients don’t understand the time constraints they are under, squeezed by health insurance reimbursements that are too low, so the doctor is forced to see more patients each day.

Doctors tell us our outcomes are less than expected because we aren’t complying with their recommended treatments — they complain that it’s often the patient’s fault when treatment doesn’t work because patients aren’t doing as they are told.

Doctors further complain that they are competing with the internet to diagnose and treat patients.

So here is some advice for patients:

Understand that the financial pressures on doctors are beyond anything they have ever been. It used to be they would see, maybe, 20 patients in a day (21 minutes average per patient). That meant they could spend a good deal of time with you to answer your questions. Now, if they want to stay in business (and we need them to!), they must see more like 50 patients in a day (8 minutes per patient) or they won’t have enough income. If they don’t stay in business, we won’t have a doctor to see — and that is already a problem — a shortage of doctors in many areas of medicine. We patients need to adjust our expectations, respecting a doctor’s time constraints.

Knowing you have less time with your doctor, prepare well to see him. Make a concise list of symptoms to report and a concise list of questions to ask. Manage your doctor’s expectations by telling him you have those lists. When he interrupts you (within an average of 18 seconds into your meeting) — then ask him politely not to interrupt. Remember — he’s used to interrupting, so you need to let him know that’s not acceptable.

Do not allow your doctor to provide an instant diagnosis. Make him think outside the box. When he provides you with a diagnosis, ask “what else can it be?” and ask him to explain why it isn’t the alternatives.

Approach your care in a collaborative way. If you have looked up symptoms or diagnoses or treatments on the internet, then warn your doctor that you want to discuss your findings. Manage his expectations that you want to have that discussion but that you are willing to make it a short discussion.

Comply with your co-decided next steps. If you and your doctor agree on what those next steps are going to be, then you have no excuses but to comply. If you run into problems, let your doctor know immediately, otherwise he will think it’s your fault that you aren’t getting better.

Here is some advice for doctors:

Please understand — I GET that you have less time per patient. I GET that your reimbursements squeeze you. I GET that you went to med school and the internet didn’t. I GET that patients are demanding more from you when you have only less time to give. I GET that your practice approach has had to shift with these new realities. I offer this advice to make your lives easier:

You will be less inclined to find problems with your patients if you begin to respect them more. They are sick or hurt. They are scared. They are looking to you for answers and guidance. You are treating them like cattle. You are interrupting them. You aren’t thinking outside the box. And yes, I realize that in fact, if you don’t do it right the first time, you just get paid a second (or third) time for doing it again. But respecting your patients should still come first.

Respect also means it’s time to stop interrupting. I GET that you are interrupting because you know your time is so short — but don’t. If you want to speed things up, then tell your patient that’s what you are doing. “Mr. Jones, please tell me quickly what you learned because I want to spend our time finding the answers for you.”

Understand that the internet is here to stay. It’s not going away. Instead of fighting it, or getting upset with it, why don’t you guide your patients’ use of it? Manage their expectations about YOUR reactions. Provide them with a flyer about the use of the internet that asks them not to bring you stacks of printouts, and guides them to good websites for their use?

When patients don’t get better, don’t automatically assume it’s because they didn’t comply. Yes, I GET that compliance is a big issue — but assuming non-compliance is once again, a respect issue. You can get to that information by asking gentle questions mixed in with symptom or test result questions. By assuming non-compliance, you instantly put your patient on the defensive, and that throws up more roadblocks.

Advice for all:

Next time you are tempted to complain about your doctor, or your patient — ask yourself if the basis stems from communication, or if it stems from time/money constraints. In either case, the “fix” is not the opposite party, the “fix” is your approach. Take a deep breath — then see if you can fix it.

That’s what fixers do. Because complaints and blame don’t get us anywhere.

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1 comment

1 ping

    • Mike Jones on December 19, 2007 at 7:37 am

    You expect a doctor to make a competent diagnosis with an 8 minute visit? Are yo serious? Take me half that time to take my clothes and shoes off… Never mind the small talk…

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