Not long ago, I got this plea from my medical students: Can’t these patients stop with all the questions? The questions — about procedures and Googled findings and alternate treatments — were getting in the way of providing good, efficient medical care, the students said.
— One student described a young woman with advanced breast cancer who was so persistent in asking for tests and procedures that the team dreaded seeing her on morning rounds.
— Another student recalled a busy orthopedic clinic where he and his resident would see up to 60 patients a day. There wasn’t any extra time for patients to ask anything that strayed even remotely outside the orthopedic zone, and so any such patient was branded “difficult.”
— A third student spoke about a very old, dying man hooked up to a ventilator in the ICU whose family refused to consider a Do Not Resuscitate order.
The ‘Difficult’ Patient
There is a difference between difficult and “assertive,” I pointed out to the students. It’s good for patients and family members to ask questions, speak their minds and not dutifully accept every recommendation. It’s great that they advocated for themselves or their family members. But to the students, these patients were impeding their own best interest, and this, it seemed, was making them feel burned out even before they received their medical school diplomas.
Another young man raised his hand. He’d spent a month working in a government hospital in South Asia. There, he told us, no patients were difficult. Patients listened. You told them what they needed to do and they did it. Simple as that.
The students pondered this for a moment. Then one asked, tentatively, whether the reason we have so many patients like this in the U.S. — the kind that ask a lot of questions — might be our focus on “patient-centeredness.” Could we be giving our patients too much room to speak? At some point, he wondered, shouldn’t our knowledge, expertise and experience trump those endless questions?
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