organized curiosity

Improving health care through research

My Doctor Doesn’t Believe Me

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My Doctor Doesn’t Believe Me

 

I recently tried a small experiment. I googled the phrase, “my doctor doesn’t believe me” both in quotes and without quotes.  Google told me there were about 969,000 results when I used the quotes and over 70 million results when I left the quotes off. When I googled “I don’t believe my patients” there were six results, and several of these sites weren’t even about not believing the patient.

In my experience with patients who experienced chronic pain, about half of them said: “my doctor does not believe me” or “thank goodness, you are the first one to believe me.”  A variant on this theme is the implication that the pain is not real – especially when tests come back normal – but that ‘it is all in your head’ or “there is nothing wrong with you.” It is disrespectful and demoralizing to patients and destroys their sense of trust in doctors and the medical community when their experiences are denied.

It is often not just doctors that can be dismissive and disrespectful. Nurses, psychologists, dieticians, physiotherapists and anyone in a medical, care-taking role can fail to treat patients as they deserve and when this happens, it destroys the whole purpose for our health system to exist.

Failure to accept patients’ experiences is not only disrespectful, it is bad medicine. A patient’s report of their symptoms is one of the most valuable tools to diagnose and treat illness. Not listening and believing one’s patients is a recipe for disaster.  Patients may not always be accurate in what they think is wrong, but neither are we.

These complaints by patients may be most common when there are symptoms that we cannot figure out. We often dismiss the complaint outright or imply it is psychologically caused. Patrick Wall a distinguished neuroscientist called this tendency to ascribe psychological causes when we don’t understand symptoms ‘the leap to the head.”

There is a movement to listen to patients better. It is often called “patient or family centred care”.  The Cleveland Clinic is probably the best known institution for its focus on the patient experience. They have a whole department focused on it. I really like the credo of Dr William E Lower, one of the founders of the Cleveland Clinic when he said in 1921:

  • A patient is the most important person in the institution – in person or by mail.
  • Patients are not dependent on us – we are dependent on them.
  • Patients are not an interruption of our work – they are the purpose of it.
  • Patients are not an outsider to our business – they are our business.
  • The patient is not someone to argue or match wits with.
  • The patient is a person, not a statistic.
  • It is our job to satisfy them.

Is keeping patients happy just a frill? I don’t think so! The research literature backs up my view. A recent large study of 2,953 US hospitals compared the hospitals with the highest 25% of patient satisfaction ratings with those in the lowest 25%. There were better care processes, lower readmission rates and lower death rates in the hospitals with higher patient satisfaction.

So what should we do?

  • Teach William Lower’s principles to students in all the health professions.
  • Transform our services to be much more patient-focused. Re-think all aspects of how we deliver care:

o    Why do we work 9am-5pm when many patients would find it better to have evening appointments?

o   Why do we keep patients waiting, sometimes for hours?

o   Which services can we deliver closer to home?

o   Why can’t patients get some care by internet or phone?

o   Why is arrogance and rudeness to patients ever tolerated?

  • Teach all staff, patient-focused skills. Capital Health has undertaken a program  to do this.
  • Remember that following William Lower’s credo, not only is good medicine and will make patients feel better but also makes professionals feel better.
  • As corny as it sounds, courtesy and helpfulness to patients is contagious.

I dedicate this blog to Andrea Crowe who taught me to listen carefully to patients.

 

~Dr. Patrick McGrath

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