Chronic Snarkopoloist: Look for Unicorns: What Do Doctors REALLY Want?
Have you ever wanted to just grab a doctor by the scrubs and say, “WHAT? WHAT DO YOU WANT? WHAT WILL MAKE THIS EASIER FOR THE TWO OF US?” This column is prompted by the most frustrating set of blog posts, texts, and teary calls I could have received this week. And it was MY MOVING WEEK. I should have been the one calling YOU. I just got here. I’m not even unpacked. I just found my deodorant in a nearly empty box with one vampire smut novel, one can opener, and an empty zip lock baggie. I mean – THIS IS MY TIME FOR CHAOS. I wanted to complain about MY WOE TO YOU.
Meanwhile – I’m frustrated. I’m done, I’m over the disconnect between doctors and patients who aren’t communicating and all this healthcare fuckkery. I’ve read article after article where doctors and surgeons think that GREAT COMMUNICATION happened while the patient thought it was the worst conversation of their lives. What is happening? Why is this happening?
A very dear friend of mine, whom I adore, is chronically ill. She doesn’t quite have the Snarkopolist methods down. She doesn’t have a primary care doctor and without that she does not have a RELATIONSHIP or TRUST. Without that she does not have anyone to regulate good quality pain control. She ended up at the ER in pain and was treated like a drug seeker. This creates a cycle of horrific anger and pain –not just for her but for all of us who love her. We then hate the ER more and all the ER doctors. Yet, a dear friend of mine is an ER doctor and I have several more personal connections who are ER doctors whom I communicate with regularly. I don’t hate them. I like them very much. This is SO CONFUSING. They are not mean people… WHAT IS THIS? WHY IS THIS HAPPENING? My friend is not a druggie and my other friend is not a bully. What is going on in the world of healthcare?
Another friend of mine TOTALLY FUCKED UP. She lied to her specialist. I mean – HELLO. How can we build trust when WE are lying? I know we’re scared. I know we’ve been mistreated. I know we smoke the puff puff pass to help us. I know we might do other naughty things. I get it. We might have sex or have std’s or do things that are embarrassing or socially frowned upon. Whatever that is –YOU CANNOT LIE TO YOUR DOCTOR IF YOU WANT TO BE TRUSTED. You just cannot. I’m beyond over it. I love you. I adore you. I hold you in my heart. BUT I AM TELLING YOU AN HONEST TRUTH MYSELF. I am grateful that you are all telling ME this stuff. But WHY ARE YOU NOT TELLING YOUR DOCTORS??? WHY? WHY???? I cannot give you the quality medical care that they can give you. I don’t want you to die. I want you to LIVE AND THRIVE.
WE MUST MEND THIS. WE MUST STOP THIS CRAZINESS.
Here. I TALKED TO A DOCTOR FOR YOU. I asked him a million questions and he took the time to answer them all. And every time something else bothered me, I asked more.
What questions would you LIKE your patients to be asking you? What would you like to tell or ask your patients?
Frankly, I’d like to think patients can ask me most anything about health issues. I’m really happy with involved and active patients.
What now? Who makes the first move in the “doctor patient relationship?” I keep urging THEM – But now what? You’re busy and they need you…
Not sure how to address this, except to emphasize the importance of finding a trustworthy doc to work with and who is willing to LISTEN.
When you find one, look for unicorns, gnomes, and other legendary creatures. There’s probably a zoo of some sort where they live… actually: you should title the column “Look for Unicorns”.
What do doctors REALLY want from chronically ill patients?
[I asked. I really wanted to know. I was interested. I think you will be too. You should listen up. Dr. Ryan took some major time to REALLY sit down and talk to us. He took the time to answer difficult to answer questions in an HONEST and straightforward way. He was sleep deprived and he thought it out and took SO MUCH TIME with me. ]
Obviously, I can’t speak for all docs. But I can give you my thoughts on what I, as a doctor, would like from patients – especially patients with chronic illnesses that I might be meeting for the first time.
1) Be patient: especially if I am meeting you the first time, it will take a little time for us to figure out how we work together and the best way to
communicate and get things done. It might be that we figure it out quickly, but more than likely we’ll need a few visits to click into a good pattern.
2) Give me a chance: especially if you have been through the medical system before and have been treated poorly, it is natural for patients to come in to the office feeling defensive and as though they need to push their agenda. I’m not saying this is wrong–in fact, I think it makes sense that patients who feel they have been ignored or disrespected in the past may feel the need to push to be heard. But remember that I have not worked with you before. I’m willing to listen to you and to hear your concerns and thoughts. Give me a chance to show that I am *not* like your other doctors.
If a patient seems to be aggressive or overly pushy it is my response to put up some shields and to feel defensive in return. If you explain what’s happening and tell me your story, then I can listen as we go and we can work together as colleagues to solve problems. Doctor/patient relationships are complicated, and good relationships require time and understanding on both sides. If I am willing to give you the chance to tell me what you think, I ask that you give me a chance to show that I am not like the doctors you might have seen before who you feel did not treat you well.
3) Tell me the truth: I need to know what is happening with you in order to provide the best care. I need to know what your past medical history is, whether you smoke/drink/use drugs. I need to know if you are able to afford your medications or not. If you can’t afford your meds, then I need to know which ones you have missed in order to make appropriate adjustments to your treatment. I need to know what you need. I will try my best to set up an environment where you feel safe and feel as though you can open up to me–and I ask you to communicate honestly with me.
What can these types things can these “labeled difficult patients” do for you or say for you? Or ask you specifically that will help you? Do you want ONE thing at a time or do you want their entire history and then a willingness to peel the onion?
I’m trained as a family doc: I think holistic approaches and “big pictures” are both necessary and valuable. As a result, starting with the big picture is good, but I’ll need time to peel the layers. It might not happen the first day, but we can make a commitment to start. I think a concise description of what’s happened: diagnosis, previous evaluations, meds, etc are a good starting point, but I think you need to be prepared for follow-up questions and follow-up visits.
One area of concern that is much harder to handle is pain meds, especially as a new patient and/or in the ER. All of us have gotten burned before, and pain med requests (even when fully legitimate) make the defenses go up. An ongoing relationship with one doctor helps a lot; trust over time makes things easer, as do the narcotic agreements many of use to ensure safe and appropriate med use. I think if you’re in the ER, explaining the nature of the symptoms and what is going on may facilitate things to some extent, but I think it’s still going to be a challenge.
If you are establishing with a new primary care doc, they may ask you to either step back on the treatment a little to see if narcotics and such are truly necessary. I recognize that puts patients in a tough spot, but I think it can be a reasonable request on the doc’s part so long as there is a willingness to resume previous treatments especially if they were helping. One thing I do when I get a new patient who is already taking chronic pain meds is to provide a 30-day prescription with the understanding that I MUST have a copy of your records in order to provide another script. That way, I don’t penalize the pt for changing docs but I also don’t feel committed to a long-term medication without reviewing the course of events that brought us to that place.
My preference, also, is that should you come in w/ a list of concerns, let’s review the list together at the start of the visit. Maybe we can handle all the issues in one sitting, maybe not. If we can’t, please understand when I try to defer something to a future visit. Your 20 minute visit is really only 7 minutes long by the time nursing, registration, charting and prescription-writing are accounted for and it’s really hard to appropriately address multiple issues at one time especially if they are complicated issues. So, again, patience and understanding on both sides of the stethoscope.
Over the course of time, I want to know what fears patients have, what concerns weigh on them, and what goals they seek to achieve: these things will help determine therapy and care. But I think these discussions must be built on a foundation of trust.
If a patient has lied to you because they’ve been afraid or abused by the medical system in the past but want to confess now – how do they do it? Should they? How do they come clean?
I think the patient should try and reveal what she’s been hiding. No relationship–doctor/patient, professional, romantic can survive indefinitely on a foundation of dishonesty. At some point, the truth will have to come out. If the patient tells the doctor, there is at least a chance to re-frame the relationship and move forward. If the doctor finds out through other sources, then it’s over. Period, done.
I’m not saying it’s not going to affect (or even damage) the relationship, but I think that it needs to be addressed. Maybe even sending a letter, describing the reasons and the context for the deception, could lead or precede the discussion. Either way, though, I think it needs to come out.
Thank you so much – gushing – gushing.
Glad to be of some service.
Ok my loves – does this help at all? A real live wonderful doctor just talked about what he would like to do to start helping with a CHRONICALLY ILL PATIENT who has been through the ringer. He gets it too. Where do we go now? I’m so over all this crap. I’m so tired of my friends being abused by the system but I’m equally tired of them abusing it. Get it. STOP LYING TO YOUR DOCTORS. STOP WHINING AND BEING JERKS TO THE PEOPLE WHO ARE CARING FOR YOU.
I want to scoop every hurting soul up and hold you for as long as I can. I really do. I’ve been there a thousand times. And some days I still am. I HAVE BEEN TREATED LIKE SHIT OVER AND OVER. But you and I both know that you cannot win at a system that was designed primarily by and for a patriarchy. We are only now coming out of it. That means it has rules and regulations that even doctors must follow. I’m not their biggest fan. But they are busted down a thousand times throughout their training and they have to heal from that crap too. We have to try not to make it worse.
The most enlightening thing you can do is be friends with someone who is a doctor. Go to coffee with one. Listen to them talk about how much they love their patients. Listen to them be HAPPY when their patients are successful. THEY FUCKING CARE. They do! They really do. But chronically ill patients are wildly soul sucking when all we do is wahhh wahhhhhh. I cannot even stand half of the chronically ill people I know who ONLY define themselves as a set of symptoms and limitations. We will never get better be we do not need to be BITTER. So we must find ways around being the soul suck on the world. We must find ways to be SUCCESFULLY SICK. Even if that looks like going to your doctor and ASKING FOR HELP – reaching out and asking for a relationship AND TRUSTING THAT ONE WILL BE THERE FOR YOU.
That does not mean for one moment that you are not trustworthy or that your doctor has the right to be a tool. But my sweets, I never want to get another call again asking me how to get out of a lie. I just don’t. I’m over it. BECAUSE YOU DON’T LIE. THAT’S WHY. We learned that in primary school for a reason. And back then, lying did not have life or death implications. NOW IT DOES. STOP FUCKING UP.
Do better. Work harder.
Makes lists of your health goals and take them to your doctor and say – HERE IS WHERE I WANT TO BE – we don’t have to get there anytime soon, but I want you on my team.
I’m writing this on a rickety old POS. I have just moved. My heart is broken. I am tired and sick and cranky and my dad is sick but I have no more tolerance for a shitty mean broken health system that will not help my friends. And I have even less tolerance for my friends who will not help themselves. LET US DO BETTER OK.
Thank you to Doctor Ryan for taking the time and the energy to make my broken heart feel better. YOU ARE A DOCTOR WHO CARES. I hope people here get it. I hope they realize how much time a busy wonderful primary care doctor who works with low income people and was tired already took to talk to THEM. To reach out and really TALK to chronically ill people about WHAT DOCTORS WANT FROM CHRONICALLY ILL PATIENTS. I hope it matters. I hope it helps. I hope doctors STOP BEING SUCK JACKASSES to real patients in need. And I hope patients stop being such complete FUCKING MORONS to their doctors and their own health.
I adore you. I write with only the best in mind for a better tomorrow for all of us.
Thank you, Dr. Ryan!
Tags: Chronic Snarkopolist Look for Unicorns What do Doctors Really Want written by Melissa Travis, feeling heartbroken when not heard by doctors, finding doctors that listen, learning to communicate with doctors, make health goal lists, managing chronic illness, managing chronic pain and chronic conditions, managing medical expectations, taking responsibility, telling doctors the truth, working well with doctors