Once in a while you will meet a “know it all patient”. It’s usually an educated individual with a science background. I’ve discussed this story with many of the doctors that I know and all of them have experienced a similar situation.
Approximately 2 months ago patient X walked into my office with chief complaint of mid-back pain. Patient X is employed in a health related environment and has some knowledge in human anatomy. The necessary imaging and protocols were followed and the conclusion was sprain/strain to the thoracic region. The diagnosis made sense, since the pain was felt upon lifting a heavy object.
The patient was prescribed the proper stretches/exercises and modalities coupled with the proper adjustment. It all started when patient X noted that the Heat from the heat/stim caused stiffness in the midback. I explained to patient X that heat has more of a sedation/relaxation effect. My first mistake was deciding to stop using heat since it caused patient X some discomfort.
The very next week, X stated that it felt better when she was adjusted P-A instead of A-P and that he/she did not want to be adjusted in the A-P position no longer. Once again I explained the purpose and the specificity of the adjustments; however, I decided that I will only adjust he/she in the P-A position.
The following week X recommended some exercises that must be integrated with her treatment. Now, the confrontation started. I explained to him/her that his/her current exercise is designed for his/her specific condition and that he/she could no longer dictate his/her care. It was a very heated conversation, considering that patient X has an authoritative personality. Unfortunately, patient X is no longer my patient.
This is a very short article. The purpose of this article is to prevent the same situation from happening to you. Do not let your patients dictate their care. We all need to let our patients know that we are the doctor and we should never compromise our decision. My mistake was agreeing with patient X when she initially made the suggestion. Stand firm on your decision. It is best to stop this behavior before it escalates into something that we are not able to handle.
Dr. Paul
Re: Who's the Doctor?
I have struggled with this one for some time. Here is the question I pose.
If a patient want's care in a certain way, and we say no, should we expect any response other than the patient leaving our office? It isn't like the 1950's when Doctors were gods. People have access to so much information, that often they come in knowing more about a condition than I know - and I'm pretty smart. LOL
As long as the care the patient is asking for does not interfere with them getting better, isn't contra-indicated, and won't affect my ability to work on the patient, then why not provide it for them?
We unfortunatley live in a world where immediate gratification is expected. Pt's think we should get them better in two visits, no one, while allowing a P.T. to take 4-8 weeks to get them 50% better. As one post said -"Why is life unfair"
I get you though - the point isn't about what people want, or even the care we actually give - it's about letting a patient direct the care. It sounds to me Doc that you feel threatened. Now I know your going to get defensive right now. Don't. This isn't an attack on you. It's just - if you know the patient is Type A, then why not go with it.
Here is a suggestion the next time this happens - and the answer I commonly use. And no, this isn't from a practice management group - thought I have been in one and got royaly screwed.
Dr. says:
"Mr./Mrs. X - It sounds like you think the care I am providing isn't the care for you, I can appreciate that. The problem is that based on my clinical and diagnostic findings, that kind of care isn't appropriate for your condition, and if I do it, I could potentially hurt you. Mr./Mrs. X, I am obligated by law to provide the best care for your condition based on my findings, and my findings don't suggest that kind of care warrented. Would you like to continue with the care I have suggested, or would like a second opinion before continueing?"
With this kind of conversation, you no longer get into a pissing match, you've acted professional, and you have actually told them you are willing to give them up as a patient. People don't understand why we treat the way we treat, and they never will no matter how much you rationalize with them. All they know is our intent, our integrity, and if they trust us.
Your problem ultimately was patient X didn't trust you. And as so, debating the finer points of care only alienated pt X even more. The only way to get trust when a patient acts this way, is to ask for the trust. Ask them directly if they are willing to trust your clinical judgement. If they say yes, you have a shot. If they so no - you saved yourself a potential lawsuit.
Posted by: Steven L. Vanden Hoek, D.C. | November 08, 2006 at 10:53 AM
Well, Doctor
I agree to a certain extent, but the patient must know who the doctor is. Chiropractic degrees are not being handed out in your local subways.
We went through an extensive education and the patient should not be given the option to diagnose his or herself by simply doing a search on the internet.
I think that it takes away from our credibility the minute that we start agreeing with the patient.
Don't get me wrong, I understand your point; however, I do not and will no longer compromise or argue treatment plans with patients. they came to my office to be treated and if they are questioning my care then they should go elsewhere.
Dr. Paul
Posted by: Dr. Paul | November 08, 2006 at 12:35 PM
Thank you for your response. Yes - if they are questioning your care they should go elsewhere. I would like to ask a question then - and I truly am interested in your thoughts.
I gather that having your opinion questioned by a patient upsets you - and I have been upset many times by ignorant patients wrongly assuming and questioning my recommendations. If the patient left, then realized that you were in fact correct, would you take the patient back and continue with care?
I'll continue the thought pattern of my questioning after your next reply.
p.s. this isn't a trick question.
Posted by: Steven L. Vanden Hoek, D.C. | November 10, 2006 at 08:17 PM
Thank you for your response. Yes - if they are questioning your care they should go elsewhere. I would like to ask a question then - and I truly am interested in your thoughts.
I gather that having your opinion questioned by a patient upsets you - and I have been upset many times by ignorant patients wrongly assuming and questioning my recommendations. If the patient left, then realized that you were in fact correct, would you take the patient back and continue with care?
I'll continue the thought pattern of my questioning after your next reply.
p.s. this isn't a trick question.
Posted by: Steven L. Vanden Hoek, D.C. | November 10, 2006 at 08:17 PM
I will probably accept the patient under certain terms. THat patient will have to realize that he/she came to my office to be treated by me.
That patient will have to follow my protocol. It's my way or the highway. I'm sorry doc, but I will not compromise or take advice from patients about how they should be treated.
If there is a problem, I will be sued and not the patient. Since I'm the one at risk, I will only go with my treatment plan that's it.
Dr. Paul
Posted by: Dr. Paul | November 16, 2006 at 07:28 AM