Physician attitudes

Before medical school, in the back of my head, I think there was an implicit assumption that all my future patients would be straightforward and readily treatable. In retrospect, by simply taking myself as an example, it should have been obvious that not all of my patients would listen to my recommendation to eat right and exercise more, not all patients would follow their medication regiments, and not all patients would give me the classic, easy to diagnose history. Having been on the wards for only 3 months now, I've already seen quite a few "difficult" patients, and often I find that my patience wears thin. I can thus begin to sympathize with the surgeon I worked with who immediately turn to me and rolled her eyes when she walked into a room with a morbidly obese diabetic smoker complaining of chronic lower back pain and headaches. Nonetheless, I believe this instance, and the many instances like it over the past month, are subtle examples of regrettable behavior.

There probably are truly "bad patients" out there, but I believe their number is fewer than we often might imagine. This doctor, adept at her pattern recognition skills and making snap decisions, seemed to have also learned to separate the "crazy patients" from the "patients with real problems". This was not an example though, that I think she should have been setting for her students. Too often, I think doctors, medical students, nurses and the like fall into trap of diagnosing a patient's "worthiness of care" far too soon: They look at the chart, see the BMI, history of drug abuse, medicare status and have already made up their minds. A patient responds to a yes or no question about chest pain with a description of every episode of reflux dating back to 1979, and the physician is pushing the patient out the door with a psych consult.

These may seem like exaggerations, but the point is that it is easy for us to slap labels on our patients. Patient W is substance abuser, Patient X is a non-complier, Patient Y is a bad parent, and Patient Z is a nut case. It is much more difficult to dig into the history of Patient W's alcohol abuse, why patient X doesn't take his medicine, why patient Y couldn't be reached to follow up on her daughter's surgery, or why Patient Z chronically malingers. In our effort to be more efficient, there is seldom time or energy to dig deeper or even sometimes to refer to someone who can dig deeper. Thus we label and make snap judgments. It seems that over time, the better one becomes at labeling, the lower the threshold for the diagnosis of "crazy" becomes. Even if such assessments are accurate a lot of the time, I believe they are doing patients as a whole a great disservice.

The practice of labeling inherently curtails the ability to empathize. Even if there doesn't appear to be any immediate effects of the terms we use to identify patient behavior, or the way we talk about patients when they're not in the room, the labels we apply belie the attitudes we keep. And eventually, I think they manifest with regrettable consequence.