Letters: Readers comment on Medical Economics stories

December 19, 2008

A word from a patient, Primary care bailout?, Arrogance in Medicine

A word from your patient

I read your editorial "Patients are a virtue" [October 3, 2008] with interest. Ever since my husband was in residency several years ago, I have heard doctors complain about how patients mess up their own health and don't listen to, or respect, their doctors. I've heard those complaints of eating in the exam rooms and cell phone calls, and how patients don't follow their doctors' orders from my own husband, as well as from doctor-friends. While I can understand the frustration, I've often wondered if doctors ever look at things from the patients' point of view.

I've had chronic health problems for years now, and I've spent more hours in doctors' offices than I care to count. I've been very lucky in having some amazing doctors, but even they are far from perfect-just as I, as a patient, am far from perfect. I've had doctors answer cell phone calls while examining me as I sit there, shivering under the paper sheet. I had one doctor whose exam table was aimed at the door so that, when my feet were in the stirrups and someone walked by whom she apparently needed to talk to, everything was visible when she opened the door and stood there talking for several minutes.

I have asked basic questions, only to get the brush-off and told to ask my husband, and I have been assured that these new tests are absolutely necessary but apparently not important enough to explain or defend.

The most caring doctors I've had have been patients themselves. They know what it's like to sit there for an hour, waiting to see the doctor. They know how frustrating dealing with the billing department and your insurance company can be, and how many patients really don't know how to find out what the insurance company pays for and what it doesn't inside its annual tome of super-fine print. They know the frustrations of the patient, and they take that into consideration every time they step into the exam room. I wish all doctors were this way.

If you want to know why we're eating, ask us. If you don't want us talking on our cell phones, then don't talk or text on yours. If you want us following your treatment plan, you're going to have to respect us enough to explain it, defend it, and allow us to make our own decisions. If you want the perfect patient, maybe you should try being one and see how it feels on the other side of the paper sheet.

CARINA GUNNERSON
Battle Creek, Michigan

Arrogance in medicine

I agree with Dr. Nancy Jane C. Friedley, MD, that lack of communication with patients is at the root of most medication errors ["Rx for medication errors," October 17, 2008]. Although time pressure may explain why many communications to patients fall short of the mark, a more significant issue is overcoming communication problems that stem from the arrogance of physicians; about 5 percent of practicing physicians are considered "disruptive."

Arrogance may be manifested in physicians who refuse to write legibly, thus passing the responsibility of handwriting interpretation on to nurses and other providers, resulting in medication errors. Arrogance may also perpetuate errors, as in the case of physicians' attempts to stymie the introduction of a systematic method of detecting and correcting errors by arrogantly labeling any system as "cookbook medicine." Technology may improve efficiency and reduce medical errors, but not in the hands of physicians who refuse to adopt the necessary technology because they arrogantly resist change.

Although many strategies have been proposed to decrease medication errors, few have dealt specifically with arrogant and disruptive physicians. Educating physicians and requiring them to take personal control of their actions are reasonable first steps-especially for physicians in training, where it has been estimated that 3 to 10 percent of medical students demonstrating unprofessional behaviors have had medical errors and malpractice suits as a result of their behavior later in their careers.

Physicians who have already established their careers may benefit from special training programs designed to help them better control their anger and outbursts. Others may benefit from professional coaching, so they can better understand how their behaviors affect patients. Pay-for-performance programs may be used to reduce payments to physicians for bad behavior. Whatever the approach, physicians must learn to put the patient first.

ARTHUR LAZARUS, MD, MBA
Chadds Ford, Pennsylvania