Difficulty With the Difficult Patient

Honesty may be the best policy, but it's important to remember that by elimination, dishonesty is the second-best policy.

George Carlin

http://consumer.healthday.com/Article.asp?AID=649346

Being a Radiologist is kind of like being a grandparent. You interact with patients, but when finished, you send them back to their regular doctor. Although we had to deal with “difficult” patients, we didn't have to take their calls at night. As today's article discusses, the problem patient is common, and has widespread impact upon our healthcare system.

These 15% of patients miss appointments, come in late, have unending questions, have preconceived, but incorrect ideas about their diseases, don't believe what you tell them, won't undergo tests, and have questionable combinations of symptoms. They don't get better, won't take their medicine, keep coming back for the same problems, bring multiple family members to appointments, want to see many specialists, suggest alternative medicines, and threaten to sue.

Of course, not all patients display all of these behaviors,, but these patterns consume a disproportionate share of doctors time,energy, and good intentions. As the article implies, many of these patients do not have medical problems, but have real or imagined symptoms related to psychological issues. By default, these patients and their problems have become the province of the primary care doctor.

Handling these people is not easy. In the past, doctors could carry these patients with some “made up “ diagnosis, treat them with tranquilizers, and not pursue expensive work-ups. If the solution was not optimal, at least little harm was done. However, in the present medical environment, doctors, especially younger ones, are reluctant to dismiss patient complaints and symptoms. Fear of malpractice or bad patient feedback motivate doctors to do what they must to make patients happy, which might include expensive and useless workups, looking for non-existent diseases.

Unfortunately, these subtleties are lost on the bureaucrats, Congressman, and Presidents' who are forming our healthcare policy. The fact that 15% of patients seen are not really sick, non-compliant, or unclassifiable is not reflected in Obamacare. New fraud rules will force doctors to treat these patients as if they were really sick. When they do not get better, more intense medicine, or psychiatric treatment will be required, but won't help much. Honesty may be the best policy, but sometimes I will take second best.