We are the 85 percent

Over the years, I have had several people in healthcare tell me that about 85 percent of patients in doctor’s waiting rooms have no medical problem that won’t take care of itself with a little time and patience, but patients have been trained to demand treatment for every ache and pain. I’m sure this made-up statistic does not appear in print or as part of any official statement, but there is a feeling that mildly sick people are a drain on a system that is already overloaded.

 It isn’t a small concern, and doctors are not entirely to blame. Patients do sometimes demand treatments that are counterproductive, which has led to the excessive overuse of antibiotics, for example. Of course, patient perception is that doctors prescribed the antibiotics, leading them to believe they are effective for mild earaches and colds. Doctors say they feel pressure from patients to “do something” about their mild condition. Patients and doctors both feel they are doing what the other is directing them to do. I would guess that about 85 percent of doctors and patients feel this way, if I were to start making up statistics.

 The result is that patients can become pushy and demanding or that doctors can become resentful of needy patients. And both conditions arise, I think, from a misunderstanding of the wishes of the other. I honestly don’t think either side wants to waste time or money on useless treatments. So, “communication is the key” to a better doctor-patient relationship, or so the shibboleth goes.

 But it is more complicated that that, of course. When I was quite a bit younger, a member of my family began having fairly vague complaints and discomfort that prompted her to see her doctor. She was overweight. She smoked. She rarely got exercise at all. The doctor told her to lose weight, stop smoking, and check back in a few months. Each time she went to the doctor, she received the same advice, even if the wording changed a little, but her symptoms became more pronounced and harder to ignore.

 Finally, the doctor ordered a biopsy, which was positive for colon cancer. She was then referred to an oncologist. On their first meeting, he said, “I wish you had come to me sooner before it had spread.” Perhaps he didn’t mean to blame her for her cancer or for her lack of treatment, but that is certainly how she heard it.  Too many of us who have experience with cancer in our families have heard, “I wish you would have come sooner,” even when the patient has been seeing a doctor regularly for months or years.

 So, patients are in a bind. If we go to the doctor at the first sign of a problem, we may be seen as hypochondriacs or as clingy whiners. If we wait till the symptoms manifest themselves more boldly, we may be blamed for neglecting our own health and causing our own deaths. Given this choice, most of us would rather be seen as frivolous. We say things like, “I’m sure it is nothing, but I watched my loved one suffer, and I won’t make the same mistake.”

 This is why healthcare providers need to show a little understanding. With the possible exception of a few individuals with some rare psychological conditions, people don’t go to the doctor for the fun of it. They trust their doctors to tell them whether their symptoms are serious enough to warrant further attention, and they aren’t looking to waste time, money, or resources. To be on the safe side, I try to tell my doctors that I only want treatments that are both necessary and effective. This takes, I hope, the burden off the doctor to “do something, anything” for me.

 

About ethicsbeyondcompliance

I hold a PhD in medical humanities with an major emphasis in ethics. I began teaching college-level ethics in 2000.
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