Saturday, April 9, 2011

Weekly Whine: Bedside manner

I've been to a lot of different doctors.

I don't have that many medical problems, but I'm a woman and I think women go to doctors more than men. We're supposed to have annual exams and are obligated to keep up with that, on threat of losing birth control. And since I move practically yearly, that's resulted in my having seen a lot of different doctors. Being pregnant resulted in a lot of doctor's appointments and a few times my own OB wasn't around, so I saw another doctor. Then joining an HMO insurance meant I had to have a primary too, so that was more doctor's appointments. And I've had scattered other medical issues here and there, so those sometimes warranted appointments. So anyway, I've been to a lot of doctors.

I've liked the vast majority of these doctors. Sometimes I like them so much, I feel bad about myself that I can't be more like them. But occasionally, I get one who has a really awful bedside manner.

I remember in med school, I was at a doctor for my annual exam and I told him I was feeling stressed out. He told me he didn't get why med students always felt stressed out, because he found med school really easy. Thanks.

Recently I had an encounter at a doctor that I was very unhappy with. Not to go into specific details, but I was scheduled for a (painful) test at the office and I said I wanted to speak to a doctor for a minute before I did it.

The tech doing the test acted really put out by the whole thing, but finally agreed. A few minutes later, they located a doctor who was between patients.

The doctor (who I had never met) came over to me with a really pissed off expression her face. She was angry before I even opened my mouth, because she had to take 60 seconds out of her schedule to speak to me. I told her I was a physician and tried to quickly explain my concerns, how I had researched the test and felt that it wasn't necessary for my specific situation (I didn't physically bring any articles because I thought that would be obnoxious). She (angrily) repeated some mantra about the test, which indicated that she was looking only at a number and nothing else. When I explained my concerns further, she said, "Well, I'm documenting that you're refusing!" And she stormed off.

I work with a lot of patients who refuse things, mostly lovenox shots. I would really hope that I don't act that way around them. I know how hard it is to paste a smile on your face when a patient is inconveniencing you, but I try to do it. If she had been nicer, I probably would have done the test. But after that encounter, all I wanted to do was leave that office and cry.

And for the record, when I later talked to my own doctor, he 100% agreed that it would have been overkill for me to do that test.


  1. I think too many in healthcare forget what it is like to be the patient until it is them or a family member. Bedside manner makes and breaks a trusting relationship.

    I always thought every staff member in a hospital should spend a full 24 hours in a patient bed, only going to the bathroom, eating, and other tasks with assistance, and on someone else's schedule.

  2. I've had enough crappy experiences with doctors that I tend to feel surprised and pleased when I end up seeing one I like. The only problem is that now (since I'm in med school) they all seem to want me / expect that I read up on whatever I think I have on UpToDate before I come in.

    Sorry about that experience with the test. I probably would have gone through with it anyway. Kudos to you for having the balls to walk out of there.

  3. NP Odyssey: I always feel really guilty trying to persuade a patient to get some painful test that I haven't experienced. Especially in cases when I know the test is probably going to be negative.

    OMDG: Yeah, it sucks that I feel uncomfortable asking questions now because I feel like the doctors expect me to know everything. Regarding the test, I've definitely refused tests before, but I did feel horribly guilty about the whole thing. If I honestly believed in any way, shape, or form that this test was being done for any other reason than for the doctor to cover his ass, then I would have done it. I actually did a modified version of the test that was more acceptable to me but not as accurate. And it was negative.

  4. i've had chronic pain for over three years now and I've seen a lot of doctors. It's almost funny how many doctors take it personally when whatever test/treatment/etc. they had recommended ends up not helping. i don't know whether it's because most doctors have no idea how to deal with pain patients or what but most of the doctors I've seen have been far from empathetic when they decide they can no longer think of anything that could help.

  5. That experience is pretty mild compared to what I've dealt with.

    But then I have all the luck!

    May you never have my luck.


  6. When I look around at the personalities in my class I shudder at the thought of some of them actually talking to patients.

    Then I double shudder at the thought of any of them actually making life/death decisions for a patient.

    I find it really difficult to have HCW as patients, it is hard to know if they just want to check their medical brain and be treated like everyone else or if they want to look at their lab results and see their x-rays, etc. People vary so widely on that, in my experience.

    A neurosurg who was a patient of mine once in the ED said right off the bat, "treat me and talk to me like I am a lay person, I am not a doctor right now". I really appreciated that he voiced his needs like that.

  7. I had a similar experience once with a home nurse. I had a pair of IV antibiotics to take for a couple of weeks and got to do them from home via a PICC line. I asked my Dr how soon I could go back to work and after looking at me like she was reconsidering letting me go home, she told me if I did 2 days of home nursing and the home nurses felt I knew what I was doing, I could go back to work the 3rd day.

    The first home nurse I saw was clearly the great aunt of SATAN himself. The more questions I asked the angrier she got. The more I told her I wanted to learn to do things myself, the more she told me that I should basically shut up and let the nurses do the work, because I was obviously incapable of doing this hard, hard work. After she left I cried for an hour.

    The next day a different nurse came. She opened my chart/folder/whateverthingy, read it, and looked surprised. She asked me if I had any questions. So I told her what had happened the day before.

    Not only did the 2nd nurse show me the oh so difficult parts of taking the meds (dude, everything screwed into place, this was not rocket science here!!), and then she told me that "more patients should be like you, willing to do things for yourself". We went over a few cautionary things (ie. "If this or that happens, call your Dr asap if not sooner") and told me to go back to work when I wanted to. And while she wouldn't say anything negative about the other nurse, she did show me my chart/folder/thingy where the 1st nurse had called me "uncooperative" and "non-compliant."

    I wound up calling the nursing company and raising red flaming hell.

    And go back to work I did. On the one hand, my boss had been convinced that I had never really been sick and was faking it to take a vacation. When he walked into my office to see a bag hanging to drip stuff into tubing into my arm, he went white and STFU. (I had rigged a thing with a bungy cord and I forget what else to a bookshelf to hold the bag up. It was a riot.) On the other hand, after 6 days I had a major allergic reaction to the vancomycin. But that's another trip to gilligan's island...

  8. I once had a dentist shove a needle into my mouth to give me local when I hadn't consented to it (it was for teeth cleaning, I get really jumpy and just wanted to try a local first). It felt really bad, like I had been violated. I ended up writing a letter to the dentist complaining and he called me and was very apologetic. It's shocking what health professionals think they can do.

  9. ABB: I try to hide the fact that I'm a doctor, if possible.

    Alice: I had a similar dentist experience as an adult where I got a shot I totally wasn't expecting. That's why I only go to dentists that come with glowing recs from people I know personally.