The difficult patient

  • Today I read a blog post in asco connection about an oncologist that has a very similar experience to what happened to me: a patient that doesn't seem to trust you, but doesn't change doctors. I am transcribing certain parts of the post, to show what is, in my opinion , wrong about the approach the patient had in her communication with her Dr.

    “Great,” I thought, as I stood at my desk, looking at my patient list early in the morning. She was coming in today. “She” was a patient of mine in her forties, with newly diagnosed triple-negative breast cancer, without nodal involvement. Our first meeting had been several months ago, and it had not been a good one.

    I had asked about her history, how she presented; she had been fairly surprised I did not have that information. “You mean, you don’t know?” she had asked. “I would’ve expected you to at least have read my chart or talked to my surgeon,” she said. even if you expect this, and it's utopic, don't ever say something like this because it a very bad way of starting a relationship.

     Then, with a sigh, she had recounted how she got to this point—finding a mass, the normal mammogram, the ultrasound-guided biopsy, receiving her diagnosis. Then surgery, more results, culminating in a referral to me. Every question I asked was met with a furrowed brow, as if I were interrupting her body language is important, and Drs have different ways of taking a history  I save my questions till the end, but not everyone does

    “It must be really shocking to be here. No one our age expects something like this to happen,” I said. 

    She had gotten angry at this. “Just concentrate on the facts, please. I don’t need your pity. What I want is your expertise.” this is simply bad manners

    We launched into a discussion about her diagnosis, stage, and natural history of the disease. She questioned everything we discussed: “Are you sure your statistics are right? From what I read, it’s more like this . . .” never ever ever say this, if you believe that your dr has the statistics wrong, say: I read this, could it also be true? I remember getting defensive, as if each question back to me was a personal attack on my competence as a physician, as an oncologist. I remember feeling flushed as we talked, trying to get my point across as clearly as possible, yet feeling that she did not (and was never) going to “believe” me. this spells disaster for a doctor-patient relationship

     

    The post finishes with the conclusion that the oncologist realized that he didn't need to "like" the patient, and when he realised this, he could treat her correctly.

    I disagree, this is not simply liking a patient, the patient-doctor is a very important relationship, and when it's as bad as this, I believe that you will get worse outcomes that if you go to a doctor that you have a better relationship with.

    I have had patients like this, that every sentence I said was met with a rebuttal, in the end I was so flustered that I didn't even remember what I was going to do with them, And I also didn't understand WHY didn't they change doctors??.

    You don't need to have a doctor that is also your friend, but you need somebody that you trust and respect.

    Again, I don't think you will get the best outcome if you have a relationship like the one described above, but if you have , change doctors!!