Caregiving: Are You a Difficult Patient?

Does your doctor see you as a difficult patient? Are you a stressed-out caregiver or an adult who refuses or questions recommendations and treatment? Or are you a healthcare professional who knows enough that you want to direct your care instead of agreeing to every recommendation made by the doctor?

Do you ever imagine what your doctor would say to you if he or she could? If you could read minds, you might hear, “I wish you would find a new doctor, or I have a sense of dread each time I see you on my appointment list.”

Even more, do you realize that every discussion you have with your physician or their staff is recorded and placed in your permanent record?  If so, you might see, “patient refuses recommendations” or “patient wants to direct own care.”

Doctors Don’t Like All Their Patients

You might be surprised to learn that “doctors consider 15 to 25% of their patient encounters difficult. Doctors with relatively high numbers of problematic patients were more likely to report that they had provided sub-optimal care or they expected to make future errors in their practice.” ⁽¹⁾

The medical profession never predicted the need for greater communication and social skills to treat patients. After all, doctors practice medicine, not consult Miss Manners’ etiquette recommendations.

Treating middle-aged caregivers and aging adults is not always considered a specialty. Not enough physicians today are interested in geriatric practice. Working with geriatricians can be extremely beneficial for older adults.

We Need More Geriatricians Who Care about Aging Adults

According to the New England Journal of Medicine (1), we need more geriatricians who are empathetic about the health conditions of older adults and sensitive to daily issues, including transportation difficulties.

While primary physicians can treat general conditions, geriatricians specialize in the health of aging adults and are more likely to be patient, understanding, and caring.

Yet, becoming a geriatrician requires additional years of medical school at a greater cost. This statement by a geriatrician highlights the frustrations of primary care physicians who lack an understanding of the challenges faced by many older adults.

“This hit home recently when a former patient of mine was “fired” by his primary care physician (PCP) because he had missed “too many” appointments. He is 78 years old, lives alone with few social supports, has several chronic illnesses, multiple specialists are involved in his care, and he has a hard time with mobility and transportation.”

Dr. House: Effective But With Poor Interpersonal Skills

If you have ever watched Dr. House on television, you know that his staff and some patients dislike him. He has few social skills but seems to pull out all the stops just at the last moment to save the patient when all else fails.

What would you rather have—a nice doctor with good social skills or a qualified, skilled doctor who is less likable? That can be a difficult question to answer.

Caregivers and aging adults want a combination of both.  We all want to feel like our doctor is interested in us even though we may only see them once or twice a year.

Demanding or Refusing Patients Can Be Viewed as Problems

Demanding patients expressing fear or frustration can be labeled problem or difficult patients in a medical chart. Documentation about being a difficult patient can impact the availability of future care and treatment.

I have likely been considered problematic at one time or another, especially when I walk out of my doctor’s office because he or she can’t keep to a schedule. Why is my time less valuable than the physician’s?

There have been other times when I advocated for a client’s wishes that contradicted the physician’s recommendations. For example, there was a time when my client wanted a particular treatment from a specialist, and the primary care doctor viewed the effort as futile. In this particular situation, my client’s wishes were honored.

Many issues occur in the doctor-patient relationship. Few doctors apologize for actually being behind schedule, yet offices threaten to penalize patients financially for being late to an appointment.

Lab tests become lost. Other times, when tests are recommended and completed by the patient, no one in the doctor’s office follows up with the patient to review the results. In this case, the patient can believe everything is okay when, in fact, a serious medical condition may exist.

Prepare for Your Doctor’s Appointment

Caregivers and aging adults have not been taught to prepare for medical visits. Patients show up and expect the doctor to diagnose their problem in 15 minutes or less, and if this doesn’t occur, frustration results.

Here is a list of actions that can be taken to improve communication at a doctor’s appointment and potential perceptions of patients who might be viewed as difficult:

• Recommendation: Bring a copy of prescription medications.  Patient perception: The doctor should know all the medications their patient is taking even though the patient sees six different doctors for different health issues.
• Recommendation: Carefully consider and ask questions about the doctor’s recommendations. Patient perception: Why change my habits or lifestyle when I can take a pill?

This article features additional tips about getting the most out of a 15-minute medical appointment.

Some patients believe that doctors really do not care when complicating factors related to poor office administration and other internal system or process challenges can occur. How many times do you really have to call to schedule an appointment because you don’t receive a callback?

Considering this, you might be surprised to learn that the healthcare system where your physician works may be paid a monthly rate for patient care by the Centers for Medicare and Medicaid to manage your care. There are two different types of physician payments: fee for service and value-based care. These can impact the quality of care that patients receive.

Knowing some of the challenges, how can the medical office challenges be balanced with patient and caregiver needs? Patients’ and caregivers’ actions and attitudes can result in frustration and burnout for physicians and their office staff.

If you are a caregiver, you may be able to relate. How many of you become frustrated when the person you care for refuses to listen or participate? Being a caregiver who helps loved ones navigate healthcare can be equally as challenging.

So what is the solution? Is there a middle ground where physicians, patients, and caregivers can work together?

How to Improve Doctor-Patient Relationships

Sometimes, scheduling an appointment can be challenging without waiting months to see a doctor, especially if you are a new patient seeing a physician specialist. Cardiologists, neurologists, and endocrinologists can have month-long waiting lists.

Caregivers and patients can also be frustrated when medical offices don’t run efficiently. Most medical offices have enough patients, but they may not have enough staff.

This can be problematic when caregivers who take time off work to accompany loved ones to appointments are delayed longer than expected at medical offices.

A medical office is unlike a restaurant, where you receive poor service and don’t tip. The service at your doctor’s office is different from a bank, where the tellers go the extra mile to be of service because they know you can take your money elsewhere.

The hassle factor in changing doctors and the issues in dealing with insurance companies make patients remain with their current doctor for years, even if the relationship is not the best.

Doctors rarely fire patients. So the bottom line is, why not work to improve the doctor-patient relationship?

Will patients receive better care if they become better patients, listen to and actually take action on doctors’ recommendations, and prepare for appointments?

What about older adults who live in care communities where physicians visit? Does the on-site care staff experience similar frustrations about resident refusals of care? 

Can improved communication, use of technology, and the availability and helpfulness of staff make a difference?

According to the research, possibly yes, because the relationship with a doctor and other care staff will change. Will your doctor’s office ever be on time for appointments? One can only dream.

If you found this article helpful, check out Pamela’s online program, Caring for Aging Parents, and the segment about managing medical care that offers tips for attending medical appointments alone or with loved ones.

Sources:

(1) Landro, Laura. The Importance of Trying to Be a Good Patient. Wall Street Journal, Personal Journal B-9, 4/29/2009.

(2) Cantor, Michael MD, JD. We Need More Geriatricians, Not Primary Care Physicians. NEJM Catalyst 6/28/17. https://catalyst.nejm.org/need-more-geriatricians-primary-care/

© 2012, 2013, 2018, 2024 Pamela D. Wilson, All Rights Reserved. 

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