Friday, July 22, 2011

Frustrating Patients

My attending and I have a pretty good relationship. Good enough that we can have a back and forth about politics (typically a no-no in the world of medical education and "professionalism"). He tends to point out my leftist tendencies and I point out his right-winged nuttiness. After 3 weeks of working in his clinic, which serves a rather impoverished part of the state, I can see his point of view.

Nearly half his patients have their healthcare covered by the state. This is great, but it seems like those same patients tend to do the worst at taking care of themselves. I don't mean eating right and exercising. I could understand if they didn't have the resources to do that. I mean they ignore doctor recommendations, then get an exacerbation of their disease, get admitted and have a hospital work-up that costs tens of thousands of dollars, get better, then go back and ignore every recommendation made to them. It's frustrating for a physician when a patient who is unemployed (and has no trouble with transport or any responsibilities at home) misses important appointments repeatedly or a patient who has all their medications paid for not taking them. Yes, some patients with good insurance also fall into this pattern, but from my admittedly short experience so far, it's a nearly universal pattern with those that are under the public health plan (and my attending agrees). One assumption I could make is that they have trouble following recommendations because they have a lot of other problems in their lives, but it's hard to tell if that's the case.

No, fear not dear readers (both of you), I'm not becoming a Republican (though my attending keeps on telling me that it's a matter of time). Rather, I think that there needs to be a shift in healthcare resources. Covering expensive medications and procedures is great, but I'd rather give those up for increased education of patients and more access to social workers. Preventative care looks great on paper, but in the real world, it only goes as far as patients know to take it.


  1. Part of the problem is that these patients often don't really understand the recommendations or have the insight to apply it to themselves. I've tried to make it a goal when I'm on the wards to take some time to educate my patients when they're captive audiences in their hospital beds, and so many of them have thanked me for taking time to explain things to them "that no other doctor has done." Even when I see them come back, most of them are coming for other reasons and parrot back to me the things that I taught them and that they were continuing to do at home. We assume that people have the insight and time and education that we all enjoy at our own peril.

  2. Yes, that's a big part of it. You're unique in actually spending the time with your patients and ensuring they understand the consequences of their health conditions. Most doctors don't have the time (especially in a typical service where one hospitalist sees 20+ patients a day). That's where social work support or health counselors can come in.