We all tend to do well with ‘good’ patients, but what are good patients? They are usually those who are near our own age, education, and social status, who possess a pleasant demeanor, and who pay promptly for our services. Unfortunately, there are not enough of these to go around. So how do we approach all patients as good patients?
Most patients are neither saints nor villains—they are just people. While most are nice, or willing to be so, some have sour, negative dispositions. If we are honest, we must admit that some physicians have this same tendency. We need to take patients as they are, and we need to take them one at a time. Start viewing patients as a group and they become depersonalized and stereotyped, often characterized by the most bothersome one we have seen recently. In fact, each is an individual with a distinct set of beliefs, fears, anxieties, and prejudices.
As we see our patients, it is extremely important for us to know our own weaknesses and prejudices, and as best we can, keep them under control. I have great difficulty tolerating whiners. Give me a crotchety, plain-spoken stoic any day. A whining patient to me is like fingernails scraped across a chalkboard. Others relate poorly to old people, children, drug abusers, chronic pain patients, uneducated patients, patients on disability, uninsured patients, dirty patients, and hypochondriacs. We all have our hang-ups, but when one of these people shows up, hold your tongue, remain amiable and make an extra effort to understand or, at the very least, to tolerate them nicely.
It’s almost always counterproductive to become short, angry, confrontational or smart-alecky with a patient. When I have done so, almost without fail, it has come back to bite me. Tell them that they are not sick or it is all in their head, and they will become critically ill that night just to prove you wrong.
Even worse, they may unknowingly make you confront yourself as I found out.
Mr. R. and his wife were immigrant Russian Jews who had been adopted by our local synagogue while they awaited permission to emigrate to Israel. Mrs. R. spoke little English. She was severely depressed and was brought to me by her sponsor, a patient of mine. Every week for three months, I saw Mrs. R. and, with the aid of her husband as an interpreter, I struggled to help her. These visits were always long, tedious and energy draining. If that were not enough, each time, after checking out, Mr. R. would ask to see me again for “just one more question.” I hid my irritation as best I could and answered his questions. One day I had finally had enough. I was two patients behind and had been up most of the night in the emergency room. I was in no mood for the one more question that followed another trying visit with his wife.
“This time, he’s just going to have to wait,” I snapped at my nurse. “Let him cool his heels in the allergy room.”
I left him sitting there for 45 minutes.
Mr. R. jumped to his feet as I entered the allergy room.
“What’s the problem?” I asked, too sharply.
Seeming not to notice my attitude or his long wait, he grasped my hand in both of his and began speaking with his heavy Russian accent. “Dr. Dew, we will be leaving for Israel in three days. I want to thank you for being so kind and helpful to Nadia.” He turned and retrieved a large coffee table volume of Rembrandt from the chair. It was obviously expensive, and he was obviously poor. “Please accept this as token of my appreciation.”
I thanked him profusely, all the while searching for a convenient rock to crawl under.
Put your best foot forward—even when it’s hard. Otherwise, it might end up in your mouth.