I had a bad week. I took care of a miserable patient with a bad problem ultimately requiring complex surgery. It wasn’t only that her ailment was unusual and required a lot of thought. That comes with the territory. Rather, it was something over which I had no control. Perhaps because healthcare had disappointed her in the past, this patient chose to offload her misery onto all her care providers. Her disdain and caustic sarcasm for the doctors and nurses trying to care for her was obvious. I found myself dreading my time with her. So, I did something I’ve never done before. I asked one of my partners to take over her care.
I typically write pieces on the broken healthcare system, how patients have been disenfranchised, how incentives are misaligned, driving costs up and outcomes down. Over the last half-century the underlying paternalism of the system has favored the provider. Lately, however, healthcare consumerism has been on the rise. Hospitals and the providers are now measured against metrics of patient satisfaction and patient experience. The resulting data can be tied directly to hospital reimbursement and employee job security.
Unfortunately, many of these metrics seem better suited for an experience at a hotel than at a hospital. Yes, the hospital experience should be optimized but it still might not be optimal.
Misunderstandings arising from this new consumerist model have been exacerbated by the current reality of the doctor-patient relationship. In the hospital most doctors do not have a pre-existing relationship with their patients. And if a doctor hasn’t cared for patients in the community before they appear in the hospital, mistakes, miscommunications or mismanaged expectations quickly spin out of control.
In the case of my recent troublesome patient, I tried to remind myself she wasn’t feeling well. I wished I had limitless patience, but I don’t. Providers are people too. In the end, I was fortunate to have help available, a colleague to take over her care. But not all doctors have the luxury of a backup. And sometimes when the care provider and patient don’t mesh, the provider will look for shortcuts. While the best outcome requires work from both the patient and the provider, at times care providers may relent, giving drugs or ordering additional studies simply to get the patient out of their office. In fact, studies have shown that the “most satisfied” patients have measurably worse outcomes.
When you’re sick or facing a life-threatening illness, it is not your responsibility to be empathetic to your care providers. However, I’d like to suggest that your care will be better if you are not only persistent but also considerate in what you ask of the care team. If you don’t understand why a treatment has been suggested, ask for explanation. If you are still not satisfied, you may then consider requesting an alternative provider.
Contrary to popular opinion, healthcare has become an increasingly stressful and not particularly lucrative profession. It is also one that by its very nature limits the solutions open to providers in cases such as this. Unlike the surly passenger on the plane, a difficult patient can’t simply be taken off the flight. I grappled with my decision to transfer care of the patient in this blog, but in the end, I thought it was in the best interests of all involved. After all, when there are so few alternatives for providers, the choice is either to withdraw or choose other potentially less optimal avenues.
Ultimately the road back to wellness is a team effort. If at all possible, patients and their providers need to be rowing in the same direction.