Are Patients Always Right?

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At one time, patients decided whether their problem was worth a visit to the doctor.

Patients were welcomed.  Minor concerns gave providers a chance to relax in an otherwise stressful day.

But, attitudes change.

Instead of welcoming all patients & all complaints, nurses and doctors get taught to judge whether patient complaints are deserving.

They learn that caring for patients with problems unsuited to their highly specialized skills should be done by someone else.

Anyone else.

Over time, providers develop strong opinions about who really needs their care.

Only the truly sick patients ‘deserve’ to be in the ED….except the very sickest of all….dying patients.  They shouldn’t have come to the ED in the first place.

Here are some of the flags nurses and doctors use to identify undeserving patients.

Undeserving patients –

1. Seek help for minor complaints that should have been handled at home.

2. Take poor care of themselves.

3. Attend the ED/clinic out of convenience.

4. Demand repeat investigations.

5. Should be seen by their family doc, or public health nurse, or not at all.

Otherwise really nice nurses and doctors adopt these attitudes.   They reason it’s all part of being a good steward of public funds and common sense.  They confuse a reasonable expectation to educate patients about options to access care – best done at discharge – with turning patients away.

 “Let’s face it: most patients don’t need to be seen.”

‘Undeserving’ patients don’t get great care.  EVER.

We need a new attitude.

We need –

to always let patients define whether their concern is legitimate.

to welcome all patients no matter how ‘minor’ their complaint.

to treat all patients as privileged – like family.

Nothing less than a new attitude, ideal and service standard will do.

If we want to change the way patients access care, we need to provide attractive options for patients.  We cannot provide few, inconvenient options for access and then train providers to hold a ‘send them away’ attitude.  This never promotes great service or care.

Changing minds will require changing incentives in our present system.  We need redesign at the highest level.  In the meantime, how are you going to change attitudes in your ED or clinic?

10 thoughts on “Are Patients Always Right?”

    1. Thanks, Andrew!

      If patients are allowed to define what they think works best for them, we could build the options around their needs instead of our desires.

      Cheers

      Shawn

  2. Good post. Over my many years of working in the emergency department this attitude is one of the things I find most frustrating. This is another example of provider centered care rather than patient centered care. In this case, the provider is the health care system at all levels as the patient’s needs and anxieties are labelled as inappropriate or in fact “an abuse of the system”. The last time I looked most people do not want to come to an emergency department and only do so because they are worried or have no reasonable alternative that they feel they can access in a timely manner. From the provider side, working in an emergency department that does not have a reasonable volume of patients with less complex problems that can be more easily helped leads very quickly to provider fatigue and burnout. Our responsibility as health care providers is, whenever possible, to help people feel better. Sometimes this may mean some kind reassurance when no one else is available or easily accessible. It also may mean timely intervention that prevents further exacerbation of a minor or chronic medical problem when the patient is unable to easily access other care in the community.

    1. Brilliant and very well said!

      I hope those out there who think like us will have enough courage to counter the ‘undeserving patients’ attitude so popular these days.

      Thanks so much!

      Best,

      Shawn

  3. Excellent points raised. Even as a young physician who is still wet behind the ears, I find myself saying some of these things. I really liked the distinction between being physician centered care and patient centered care.

    I really recommend people read this article: Han A., Ospina M.B., Blitz S., Strome T., and B.H. Rowe. Patients presenting to the emergency department: the use of other health care services and reasons for presentation. Can J Emerg Med 2007;9(6):428-34. PMID: 18072988.

    It really opened my eyes to how much of the issues we face are created by the way we organize and deliver healthcare in our system.

    1. Hey Paul!

      Thanks so much for reading, commenting, and suggesting an article!

      I’m guilty of saying or thinking most of the things in the post. We, providers, get GREAT service…so, how are we going to provide this for all our patients all the time?

      Thanks again!

      Shawn

  4. I do have the “new attitude” as defined in your post.

    But I can’t be available 24/7/365 for them.

    So what is the compromise for the patient seeking care for a cold or back pain at 2 am in the ER because he/she works until 1 am and sleeps in the daytime?

    I haven’t read about a solution yet and hence, the old attitude continues, especially when physicians are being blamed and financially penalized for the perceived overuse.

    Pointing the finger at health care providers for having attitude when they are being browbeaten by the patients, the government, and their peers will only serve to foster more attitude and despair, and that leads ultimately to burnout.

    1. Great comments, Monique!

      I agree 100%. We have limits. We cannot be available all the time. Patients own responsibility for their own decisions, too.

      This post tried to get at the disdainful attitude that creeps in when we start thinking patients should have sought care somewhere else. It grows when incentives are misaligned. When doctors and nurses get just as much income for seeing few patients, we start to resent the extra effort required to manage extra patient complaints. It starts with the nasty, rude, demanding patients. Then it progresses to the patients who come when it’s most convenient for them (how dare they!). Soon, we resent patients coming to the ED when they have a DNR in place, and all sorts of other issues, too.

      Until we align incentives such that we want to see all patients, no matter what their issue, we will always fight against the threat of resentment.

      But your points still stand! We have limits and cannot be everything to everyone all the time.

      Thanks so much for taking time to comment!

      Best,

      Shawn

  5. I am an enthusiastic myself.I work in ER as well.
    I agree we shouldn’t turn any one away, even more abussive drugsickers, or hard core hypochondriacs, but what about common sense?
    Picture a a family ,where father is working and the rest just spending money.
    One day the father says ” We have no money to spend” you have to be careful and every body starts to scream and the mom says to father ” How could you be so rude to tell them about reality” Sound familiar?
    Sometimes I feel that it doesn’t matter how much you do it never enough or not wright for a person.
    I know GP s ,who start day with walk in clinic for their patients at 6 am and nevertheless I see their patients at 3 am with trivial things that going on for month or years.I saw a guy who’s appointment with GP was at 9 am, didn’t want to wait, came to ER at 8 am seen at 11:30 am!
    Paternalistic aproach in medicine is outdated. We, health professionals can’t fix the system by our selfs without direct involvement of the population.
    Also patients ought to know that health professionals are human beings too!!
    We compassionated, caring, but also can be sad, moody and yes we cry as well.
    Few month ago I lost a teenager after 2 hours of resuscitation and when it was all over all my staf fell quiet I suddenly heard a loud laughing and swearing at my nurses , complaining about waiting to long! There he was – young drunk self absorbed “patient”. He even didn’t noticed that he was on the one most expensive stretcher in resuscitation room. Entitled? Naive? Uneducated?
    Not his fault – agree, but nighter mine or yours.
    We don’t need to invent a wheel, it is already here. Let’s look at the Netherland,the country with the best health acces index in the world and learn from them.

    1. Wow. Great examples, Tatiana! Thanks so much for sharing these.

      You touch the heart of our challenge. How can we keep our compassion for the angry mom demanding we see their baby’s diaper rash after we just told a young family that their baby just died? It seems impossible. It seems unjust. But does it give us a pass on being kind to the angry mom?

      We all have limits. We cannot pretend to be super-human. I’ve even apologized to a few angry moms by explaining I just had to deal with a failed resuscitation. The moms barely flinch.

      I think you nailed it by suggesting we need system change. More on this soon, I hope.

      Thanks so much for taking time to read and share your thoughts!

      Best regards,

      Shawn

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