The Angry Patient

I’m not sure though, that people could as readily accept that being a doctor could be miserable. I don’t think most could find it in the bottom of their hearts to care. After all, doctors in America are not only the reason healthcare is a mess, they also make too much money while being greedy for more. For when it comes to money, doctors collectively don’t need to work for a living, they are just inherently filthy rich. And yet they, doctors, complain. They complain so much! Sigh!

 

It’s one thing for a plumber to come to your home to fix a leaking faucet and bill you a couple hundred dollars. It’s another for the auto mechanic to have on his wall “$80/hour labor”. But it’s highway robbery for a doctor’s office to demand a $35 copay for an outpatient visit. “I pay heavy premiums for my health insurance so why should I pay on top of that?” is the general sentiment.

 

Yet whatever the insurance company chooses to reimburse the doctor is very often less than what was billed for. I have heard from doctors who have received insurance reimbursement checks for two cents. Two cents. Imagine that! The paper, the ink, and the postage all cost more than the value of the cheque. I have also heard of scenarios where the reimbursement check is sent to the patient directly and instead of forwarding it to the doctor’s office, the patient cashes it.  Surely they need it more than that rich doctor. And without any feelings of guilt, said patient will call asking for a same day urgent visit or will bring in forms the size of an encyclopedia to be filled out.

 

We, society, accept a lawyer’s bill that includes the cost of each staple, paper clip, sheet of paper, and time on phone expended on us, yet expect a doctor to fill out reams of forms not limited to FMLA, disability, workman’s compensation etc., while returning call-backs from everyone and their mother, and while pleading with insurance companies all on limited time and all for free.

 

But that’s the system. No profession is perfect but I don’t enjoy being the media designated bad guy for everything that is wrong about the health of Americans and the state of healthcare delivery in the country. But there’s something far worse. What I cannot tolerate is the unacceptably rude behaviour of too many patients. It’s uncalled for! What did I do to deserve a rain of expletive tirades directed towards me? Why do I deserve to have my brains blown out? Why am I the enemy for having walked into your hospital room with a “Good morning, I’m Dr. Aggrey, the infectious disease specialist” on my lips. I don’t understand the vitriol.

 

Not too long ago, I was brought to tears. Granted, I am a cry-baby whose main coping mechanism is to protect my heart with a giant concrete wall. Thus I don’t get personal and most rude encounters I survive without much fanfare. I know an angry patient’s aggression and hostility is not about me. I lie to myself and say “being sick is miserable” when I know that people like that are just mean and miserable all the time. I have had too many pleasant encounters with sick people to know that rudeness and sickness are not synonymous. In fact, there are times when I meet a patient, usually a World War II era senior citizen, who heals me just a bit by their bedside manner. They bring me to the brink of tears of gratitude. How did the stars align for me to be able to help heal this wonderful old soul, I would wonder, looking forward to our next encounter and really wishing them well from the bottom of my heart.

 

This particular instance though I must have already been feeling vulnerable. I must have let my guard down, got too comfortable with sharing my life with others outside of medicine, maybe had met one of those lovely senior citizens who appreciated me, something. This particular patient had come to the hospital with a problem that he had ignored for too long, a problem that required urgent corrective surgery. He had a number of complications least of which was an infection for which yours truly was called upon to manage. Well. He was angry at me for his infection. Imagine that! I was the problem and in no way part of the solution. Why I had to interrupt his TV show or his beauty rest to talk to him and to examine him was incomprehensible and unforgivable. Worse, the surgeon, the only real doctor among the nephrologist, hospitalist, and pulmonogist also on the case, had not told him that I would be coming to disturb him. Furthermore, the dressing over his wound “didn’t need no changing”. And if my purpose was to start or change antibiotics then why couldn’t I just talk to his doctor, the surgeon? Why couldn’t I simply leave a note at his bedside table with “whatever shit I had to say”?

 

I wrote up the encounter in his medical chart documenting all his colourful words and phrases verbatim while hot fat tears streamed down my face. After speaking to his surgeon, I signed off his case, but not before entering orders for the antibiotics he needed. I wasn’t going to chance returning for more verbal abuse.

 

It’s tough to argue with someone whose knowledge is based on ignorance. To compound, I get exasperated with ignorant people since I cannot bring myself down to their level. Their logic does not compute and I’m left like a robot with wires gone haywire. So normally in daily life, I avoid ignorance when I can. But this is work.

 

Medicine has come a long way over the course of the past century. Remarkable leaps and bounds. Yet, we are still human and each one of us will still die someday. Honest truth, death comes to everyone even if we do “everything possible” to fight it off. Along the path to death we age and we get banged up. Yet, we delude ourselves with the fantasy of what modern medicine should be able to achieve. We live in a time where youth and youthful features are praised and highly desirable. We do not want to grow old and with all our advances it’s a travesty that us humans should even become decrepit over time.

 

We believe not in fate but in fault. Somebody has to be responsible for a less than desirable outcome. Often in healthcare that person is the modern doctor.  It is not the obese patient facing leg amputation who smokes 2 packs of cigarettes daily, doesn’t take their insulin, and refuses to be non-weight-bearing but rather the surgeon who failed to debride the antecedent wound properly or the infectious disease specialist who failed to give the correct antibiotics or didn’t give antibiotics long enough ie. forever.

 

It is not the gang-member now paralyzed after a shoot-out with a rival gang but rather the surgeon who could have possibly done something but was already in the operating room doing an elective operation on someone else and failed to split herself into two parts to be in two places simultaneously. No, the responsible party of a bad outcome in healthcare is not the insurance company who wouldn’t give authorization for a certain medication to be used or surgery to be done, not the hospital administrator who didn’t think it necessary to have a back-up surgeon available in the case of an emergency, not the midwife who kept a labouring mother at home a second too long, not the doula, not the chiropractor, not the nurse, not the physical therapist, and most certainly not the politician making all the rules. No! All bad outcomes are squarely the doctor’s responsibility.

 

We, society, believe so much in the fantasy of the unlimited boundaries of modern medical science that when our expectations are not met, we deem the whole thing to be a racket, a fraud, and a conspiracy. There is a cure out there for HIV/AIDS as well as for all the cancers, they are just keeping it for themselves. There is a better medicine for hypertension or for diabetes but they don’t want to release it because they rather keep us paying for medications every month for the rest of our lives. We don’t even need medicine let alone vaccinations! That’s all a lie. That stuff is just poison. They are just priming us from even before we are born to be lifelong consumers of unnecessary treatments. We can find the same benefit in this tea or that herb; this yummy milkshake or that health drink. We don’t need hospitals to birth our babies in, we can do it all on our own or at most with only a loving and attentive doula at our bedside each and every pregnancy.

 

So, pray tell, how am I supposed to interact with a person whose initial impression of me, based solely on the letters DR before my name, is mistrust, disbelief, disdain, and contempt. I am not a miracle worker. Never was God. Currently am not God. Will never be God. I have never professed to be omniscient. I am but a mere mortal who has spent many years learning not only the science but also the art of medicine, and who for the rest of my life will always be a student of medicine.

 

I don’t even have a crystal ball. Shocking I know. A patient can’t walk into my office and when I ask “how can I help you today?”, their response is “I’m sick”, and when I press further with “and how are you sick, what’s going on?”  they offer rudely “I don’t know, you tell me, you are the doctor!” Hmm, let’s see, I suppose at this time I could throw some gnawed-upon chicken bones into my cauldron and see what it tells me about what ails them, as, guess what, I still don’t have a crystal ball. Or maybe if I close my eyes and lay my hand over their head forcefully while chanting magical words, their illness and the necessary cure will come to me.

 

On the other hand, if the patient knows more than me because they’ve consulted Dr. Google then why are they sitting in front of me in my exam room arguing with me. What’s there to gain? Why do they even bother to allow stupid greedy me to waste their precious time and steal all their life earnings when they already know what ails them and what they need? Why, if they hate doctors, do they have to tell me that? Did I drag them out of bed under duress and bring them into my office? And what exactly is the aim of telling me that? Endearment? Ugh! I don’t understand. Sometimes, people are just something else.