Patients think you're a miracle worker? Watch out!

A "Superdoc" specializes in clairvoyance, total availability, instant cures, and complete absence of a personal life.

By Elizabeth Pector, MD
Family Physician/Naperville, IL

Patients sometimes accuse doctors of playing God. Well, I've met a few egotists in our profession; who hasn't? But most often, patients are the ones who act as though physicians have powers that only the Almighty could possess. They'd like us to be all-powerful, all-knowing—and always available.

Consider the woman who once called me on her cell phone, from a campsite three hours away. She was having cramps from her bladder infection, she said. She asked me to phone in a prescription to a conveniently located drugstore in the nearest town, so her husband wouldn't have to search for one. I politely informed her that I didn't have a phone book or map for a small town 150 miles away, and suggested that it might make more sense for her husband to drive to a nearby town, find an open pharmacy, and have the pharmacist call me.

Another time, while I was fielding patients' calls during my son's baseball game, a patient traveling in Arizona phoned to ask for the name of a specialist in Scottsdale who'd accept her insurance. Unfortunately, I hadn't gotten around to memorizing the names, specialties, and insurance affiliations of all the physicians in that state, so I wasn't able to help.

Then there was the fellow who called me at 6 on a Friday night to complain that he'd had nasal congestion for a month and had tried all the over-the-counter remedies, to no avail. He'd never seen any of the physicians at my office, but he'd somehow chosen us as his doctors, anyway. I offered to schedule an exam for the next day, but he broke in: "Can't you just tell me what I have, and what to take for it?" It was touching, his faith in the clairvoyance that enabled me to diagnose and treat—by telephone—patients I'd never even met. He must have wondered why I even need an office.

Some patients hate managed care. But a few seem to like it—having fallen for a sales pitch, from what I gather. "So long as I'm in the plan, you doctors will keep me 100 percent healthy, plus just generally take care of whatever I might need," goes the theory. I'm exaggerating, but only slightly.

One woman presented with a request for medication to delay her menses, so she could attend a religious festival two and a half weeks later. I don't know of an effective means for accomplishing this, except for pregnancy, which I hesitate to prescribe.

A businessman with a 103-degree fever came to the office saying he had to fly to Australia the next day, so I had to cure him. I wonder how many of his fellow passengers had their vacations ruined by a mystery virus. Another fellow called me at 7 one Sunday morning, saying he had a sinus infection and needed a prescription for an antibiotic. He asked me to phone one in to the closest 24-hour pharmacy. He intended to take his family to the zoo later, and he knew he'd feel much better after the first dose. At least he didn't ask for directions to the zoo.

Some patients seem to think we're not only omnipotent but omnipresent—open all the time. Hey, even a 7-Eleven store can manage that, so why can't all physicians "doc around the clock"? How dare we let details like a private life stop us?

One patient literally screamed at my staff that she had to see me on a Tuesday, a day when I don't have office hours. Another patient, who'd picked me at random from his insurance plan's physician list, rated me "poor" on a satisfaction survey because I didn't have hours on his day off.

The most outrageous expression of this attitude came from an elderly patient's son. My nurse called to inform him that his mother's appointment would have to be rescheduled with another doctor in my group, because I was on emergency maternity leave. The son sputtered, "If I ran my law practice as undependably as you run your office, I'd be out of business in a flash." Somehow, I never got around to apologizing for the inconvenience.

If we have no right to our own medical problems, then taking vacations is truly inexcusable. A former associate of mine—a dedicated practitioner who has been working 60-hour weeks for 15 years—had one longtime patient who still complained bitterly that the doctor was "never around when he's needed." On the two occasions when this patient required unexpected medical attention, my associate happened to be on vacation. How thoughtless!

Patients seem particularly clueless about our on-call responsibilities. A few people have asked whether we take turns staying up all night, in case somebody calls. One doctor I know routinely received calls from a nervous mother around 3 am, for advice about such "emergencies" as diaper rash and teething. These early-bird calls ended abruptly when this doctor turned the tables. After a wee-hours delivery, she called that mother and cheerily said, "Good morning! I just thought I'd call to see how your daughter is doing today."

Besides expecting us to be all-knowing, all-powerful, all-hours miracle workers, some patients think we should greet all their requests with a smile.

For example, a gentleman who'd just arrived in this country came to my office for a get-acquainted visit—during which he expected me to complete an immigration form, decipher four booklets containing foreign-language records of his immunizations, and administer any needed vaccinations to him and his wife, who'd come along unannounced.

Another patient, who walked in without an appointment, said she was going on vacation and couldn't visit a pharmacy, so she'd come by to get some free samples—for a condition she might get while out of town. She was extremely dissatisfied to learn we don't treat without evaluating patients, and don't prescribe medication for hypothetical conditions.

Thankfully, patients like these are the exceptions. Most see us as fallible mortals, much like themselves. They know there are limits to our profession's power, and to each doctor's wisdom and patience. And they're considerate enough to apologize if they have to bother us at home.

That's why the harsh thoughtlessness of that attorney—the fellow who groused when my troubled pregnancy interfered with his mother's appointment—didn't affect my relationship with his mom, or my interactions with his two sisters, who lovingly coordinated her care as she weakened toward the end. I found it gratifying to pay a home visit to those three women when she was near death. That call was partly an obligation, but it was also motivated by the compassion doctors generally feel for patients. Encounters like that one more than make up for the unhappy moments provided by those memorable few who expect God on call.

 

Elizabeth Pector. Patients think you're a miracle worker? Watch out!. Medical Economics 2001;6:100.