There's a doc I've encountered twice, one for myself and once when a family member was hospitalized. On one of those occasions, he was pleasant, professional, and efficient. On another--maybe he was having a bad day, I don't know--he was impatient and then became extremely unprofessional --got into an argument with the patient about something the doc was objectively incorrect about and the patient was correct--EMR was consistent as well with the patient's info, then when patient disagreed the doc bizarrely said he was going to prove he was right by calling the patient's designated proxy, which escalated the argument; in the end the doctor fired the patient in the hospital and another attending took his place but it was the patient, not the doctor, who was labeled as "difficult." Unfortunately, this label followed the patient, who ended up changing his insurance to get away from the network where this occurred.

How about we agree--doctors have hard jobs (not, actually, all of them, but enough of them). Patients have hard jobs--while they are sick or hurt they ALSO have the "job" of managing life, insurance, and the universe (today, after several months of repeated days off trying to sort out helping someone get a procedure which implicates several medical conditions, involving 3 different provider networks, and trying to get a handle on getting insurance authorization, I ended up pretty much where we were 5 months ago. I've learned some facts that I couldn't have known before, but it still means tackling the entire business again, and is going to involve repeat visits to various specialists since so much time has passed trying to make this happen).

Increasingly I get the sense that doctors and patients are adversaries.

To some degree I think the "trust" thing has a lot of unfortunate carryover from traditions that disappeared with the horse and buggy. Back then, the doctor was the person who knew who had syphilis, who got pregnant outside of wedlock, who was a secret alcoholic, who had confessed things that weren't even medical in nature because a doctor was like a priest. (Of course, in today's political climate, we might be headed back there.)

This is very much less the case. The argument has been made for decades by some that healthcare should be based on market principles and consumers (not "patients") should be shopping around for the best deal in terms of cost and quality. Not only has the internet spawned customer service ratings, but corporate healthcare has also jumped on that as well (a family member had 144 medical appointments in 2022, including tests and therapies, every damn one of them meant a robocall from their customer survey people). For a large number of people, medical care is routine--minor illnesses and injuries and screenings. The concept of a sacred trust does not come into play except in terms of HIPAA rules and ordinary professional standards. For another segment of people, medical care is a very large part of their lives. Because scope of practice is increasingly limited, they see many more different doctors and are much less likely to have a single physician to shepherd them through all this. Marcus Welby (showing my age) would pop into the hospital to see his patient even though he was not their attending physician. That's not a thing for most people.

When it gets to be adversarial most of the time it is individual battle zones--the patient who fires doctors, the doctors who fire patients, the doctors fearing lawsuits (which very rarely end up favoring patients anyway, don't help patients with terrible outcomes that could not be helped, and only rarely are the vehicle to get rid of incompetent or unethical doctors). NONE of this is healthy for any of us.

Anonymous wrote:

Anonymous wrote:I think it is problematic when doctors are not open to polite questioning and they aren't receptive when you inform them that they were in fact wrong. Sadly sometimes the only way they are forced to truly accept they are not God and were wrong is through a lawsuit. I wouldn't be surprised if many lawsuits could be prevented by a doctor simply checking his/her ego at the door and admitting he/she doesn't know and needs to refer.

My cousin is dead. Her cocky internal medicine doctor and self-important GI doctor told her she had anything from IBS to gluten sensitivity to she just needed a good shrink and it was in her head. She dealt with endless rude speeches, ego meltdowns and belittling. She got fired from doctors or had to leave doctors and was desperate to find some one who could get over their ego and judgment and listen. Then she ended up violently ill in the ER and she was diagnosed with late stage ovarian cancer. It was a pretty miserable death. I don't know her if her husband ended up deciding to sue to rudest doctor. he did let him and his superiors know the mistake and there was no response. No remorse. No gratitude for the update so they are more attuned with the next patient.

I am so, so sorry.

My sister was diagnosed with pancreatic cancer in the ER after a year of severe illness and pain, she wasn't dismissed or belittled but besides the pain she was losing weight rapidly (70 pounds in 7 months, she had been about 50 lb overweight) there was a lack of urgency and a feeling that her referrals amounted to chasing random rabbits (for awhile they were very interested in a spot on her bladder which turned out to be benign cyst, but taking time to set up biopsy for that took weeks and really didn't seem linked to her symptoms--which originally were due to suspected gall bladder disease yet did not resolve after gall bladder surgery; they should have kept looking at that region of her anatomy). The ER visit was because she couldn't take the pain anymore after 7 months, and it was the ER doc who was put in the position of giving her the awful news of a mass in her pancreas. It took a biopsy to confirm but he knew what he was looking at.

Very similar situation with my mom. Pain for years, no diagnosis. Lots of doctor visits. Finally decided it was her gall bladder. Pain did not subside after gall bladder removed. Finally had a scan that showed a tumors in pancreas and liver. Cancer. The cancer metastasized and it's too late. Years went by of complaints which we now know are very common pancreatic cancer symptoms. Nobody took her seriously or really tried to find the answers. She's screwed.

Anonymous wrote:I think it is problematic when doctors are not open to polite questioning and they aren't receptive when you inform them that they were in fact wrong. Sadly sometimes the only way they are forced to truly accept they are not God and were wrong is through a lawsuit. I wouldn't be surprised if many lawsuits could be prevented by a doctor simply checking his/her ego at the door and admitting he/she doesn't know and needs to refer.

My cousin is dead. Her cocky internal medicine doctor and self-important GI doctor told her she had anything from IBS to gluten sensitivity to she just needed a good shrink and it was in her head. She dealt with endless rude speeches, ego meltdowns and belittling. She got fired from doctors or had to leave doctors and was desperate to find some one who could get over their ego and judgment and listen. Then she ended up violently ill in the ER and she was diagnosed with late stage ovarian cancer. It was a pretty miserable death. I don't know her if her husband ended up deciding to sue to rudest doctor. he did let him and his superiors know the mistake and there was no response. No remorse. No gratitude for the update so they are more attuned with the next patient.

I am so, so sorry.

My sister was diagnosed with pancreatic cancer in the ER after a year of severe illness and pain, she wasn't dismissed or belittled but besides the pain she was losing weight rapidly (70 pounds in 7 months, she had been about 50 lb overweight) there was a lack of urgency and a feeling that her referrals amounted to chasing random rabbits (for awhile they were very interested in a spot on her bladder which turned out to be benign cyst, but taking time to set up biopsy for that took weeks and really didn't seem linked to her symptoms--which originally were due to suspected gall bladder disease yet did not resolve after gall bladder surgery; they should have kept looking at that region of her anatomy). The ER visit was because she couldn't take the pain anymore after 7 months, and it was the ER doc who was put in the position of giving her the awful news of a mass in her pancreas. It took a biopsy to confirm but he knew what he was looking at.

After some very difficult situations with healthcare for a family member who is medically complex I started following a lot of online medical information, including r/medicine on reddit to get a sense of healthcare from the provider perspective. Very eye-opening and this topic comes up pretty often.

We have a physician shortage. I'm in the midwest. The family member had tried to get in to see his PCP, who turned out to be double booked the entire day. He managed (had to push the issue) to be seen at a specialist clinic that has seen him before (they ended up prescribing antibiotics), but learned that if he had not been on their books they were not taking new patients. This is with the biggest healthcare network in our area. This week I mentioned it when I called my PCP office to confirm what orders had been made (I need a mammo and a bone density test) and mentioned this to the receptionist. She said they are scheduling new patients for 2025.

In 1980 there was an influential report predicting an oversupply of physicians, as a result of which (this was pretty well planned out based on how long it takes to turn a college student into a physician) beginning in 1990 med school admissions and residencies were cut. Corporatization of medicine, dealing with health insurers, and Covid have pushed out a lot of doctors, and many more are looking to bail.

I've heard from people moving here from the east coast they were surprised by the relative lack of independent physicians (fwiw, the big network we are part of was blocked by DOJ anti-trust actions from acquiring one independent practice, and more recently the state has passed a law saying that their insurance business--they do that as well--can no longer categorically deny participation from independent providers). I'm told the problem with access is nationwide but am indeed curious to know what is happening elsewhere in the US.

In the corporatized environment, it seems patient reviews can have a big impact--how much in real terms vs subjective reaction I don't know. I also don't know how skewed reddit is as a picture of physician perception, but there seems to be a lot of cynicism across the board.

As to being fired--they have to inform the person and provide care for 30 days. Subsequent providers will be wary of patients who have been fired. EMTALA protects emergency care access though.

Anonymous wrote:

Anonymous wrote:PS: There's a difference between "asking questions" in a polite and respectful way, and asking them in a way that comes with insults, rude challenges, and an insistence to do excessive work for free when it isn't medically indicated.

Challenging a doctor is okay. They are not gods, and we are the ones who will die if they are wrong.

Dramatic much?
The vast majority of reasons for going to the doctor are for minor ailments. I’m concerned that you feel like you will die when you go to the doctor.

Anonymous wrote:Not the OPs question, but it baffles me that people go into a doctors office for a first visit with the mind frame that the doctor is going to try to harm them. Do you also meet with your child’s teacher with the mind frame “this woman is going to try to make my child hate school unless I beat her into submission during our first meeting”.

As I typed that I realized that yes, some people actually do do this I think. What an exhausting way to live.

A friend of mine had a heart attack and my first thought was that I hope no one hurts her.
I have been in many situations where myself, or my children were harmed by top-notch medical care.
For those of you who think I need help I absolutely do. I went to cognitive behavior therapy to learn how to walk into a doctors office. I have a chronic life-threatening condition and have found care that I trust.
Medical trauma is real

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:PS: There's a difference between "asking questions" in a polite and respectful way, and asking them in a way that comes with insults, rude challenges, and an insistence to do excessive work for free when it isn't medically indicated.

Challenging a doctor is okay. They are not gods, and we are the ones who will die if they are wrong.

Of course it’s ok, as in it’s legal and it’s within your right. As you say, it’s your body, and you can challenge the doctor every step of the way as they try to help your body. But that’s exhausting for your doctor to be antagonized at literally every turn and while you might think, “who cares?”, your doctor is going to dismiss you from the practice or, as PP said, start ordering a zillion tests and say “take your pick, do any of these that you’d like” even though that’s against their better medical judgment. If you don’t trust their medical judgment, why not just move on to someone else??

There can be a back and forth. A conversation. That does not mean you don’t trust your doctor, rather you want to be sure you agree with what she is recommending.

DP. No, absolutely. When you have a civil conversation that is a reasonable back and forth about recommendations, the basis for recommendations, pros and cons, like a pair of adults? That's fine. If it's going to be a long conversation, or likely so, it should be something both agree to set aside time for, then sure.

We can have those conversations online in some forums, with some people. They are great conversations, and they make for the best kind of informed health care, including when people disagree with professional medical recommendations.

But it shouldn't be 4chan in that doctor-patient relationship, or DCUM Political Forum, or the YouTube comments under a video of Taylor Swift at the Super Bowl. We all know the difference between civil discussion and an edgelord coming in from the side quoting Ayn Rand with a side of "you're not my supervisor!"

Nobody knows how any of us really are when we are in a private conversation like that. I can tell you all day long how I am as a doctor (or how I see myself being, granted), or even how I am as a patient -- and you can sneer and call me any names you like. Or we could speak civilly about it, or whatever. The crux of it, though, is that people need good healthcare, and with emergent crises aside, good care never comes when people are working in opposition to each other. If they are, it's the professional's job to end that, not prolong it. If it's not helping, it isn't helping, and it's unethical to take money for it regardless.

Anonymous wrote:Don’t pretend all doctors keep up with the literature/current guidelines. Many of them do what they were taught in medical school or follow their gut, regardless of the evidence base.

The hours and hours of CMEs I have to complete every year to keep my license current disagree with you. But yes sometimes guidelines are population based instead of individual patient based. Sometimes my gut tells me this particular patient needs a pap more than once every 3-5 years despite the new recommendations saying yearly paps aren’t necessary for most women.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:PS: There's a difference between "asking questions" in a polite and respectful way, and asking them in a way that comes with insults, rude challenges, and an insistence to do excessive work for free when it isn't medically indicated.

Challenging a doctor is okay. They are not gods, and we are the ones who will die if they are wrong.

Of course it’s ok, as in it’s legal and it’s within your right. As you say, it’s your body, and you can challenge the doctor every step of the way as they try to help your body. But that’s exhausting for your doctor to be antagonized at literally every turn and while you might think, “who cares?”, your doctor is going to dismiss you from the practice or, as PP said, start ordering a zillion tests and say “take your pick, do any of these that you’d like” even though that’s against their better medical judgment. If you don’t trust their medical judgment, why not just move on to someone else??

There can be a back and forth. A conversation. That does not mean you don’t trust your doctor, rather you want to be sure you agree with what she is recommending.

Oh absolutely and I encourage that. The patient should always understand , to the best of their ability at least, why I am ordering or not ordering a test for example. But having a conversation to make sure my patient understands my reasoning is different than “I read 84 articles about 19 different possible differential diagnoses for my stomach pain and I am going to aggressively quiz you on the difference between an ultrasound and an MRI for each of these diagnoses and ONLY when I am fully satisfied will I agree to get the ultrasound. But then I’m going to call you at 10pm to discuss it in detail as soon as it pops up in my patient portal”. I can’t do that. You need a private doctor.

Anonymous wrote:Don’t pretend all doctors keep up with the literature/current guidelines. Many of them do what they were taught in medical school or follow their gut, regardless of the evidence base.

Exactly who said they all did?

They all do have a medical license, if they are practicing medicine, and that license is something they put on the line regarding their judgment and actions if they accept to take on a case. They can't accept if they can't work with you.

If the doctor is an a## who won't work with you, then you don't want them. Obviously.
If they are someone who is worth working with, they still put that license on the line and have to make the call that they can take on what you bring to them.
- If they feel they can't (outside scope of expertise, time constraints, other factors), then you don't want them. Obviously.
- If they feel they can and are willing to take on the responsibility, then you work together, not in opposition.

None of the doctors who have been complained about in this thread seem to be of the latter type, the kind you actually want. I don't see the relevance of complaining about not being able to work with doctors you actually don't want to work with anyway. it's irrelevant to this thread, and in life in general.

Don’t pretend all doctors keep up with the literature/current guidelines. Many of them do what they were taught in medical school or follow their gut, regardless of the evidence base.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:PS: There's a difference between "asking questions" in a polite and respectful way, and asking them in a way that comes with insults, rude challenges, and an insistence to do excessive work for free when it isn't medically indicated.

Challenging a doctor is okay. They are not gods, and we are the ones who will die if they are wrong.

Of course it’s ok, as in it’s legal and it’s within your right. As you say, it’s your body, and you can challenge the doctor every step of the way as they try to help your body. But that’s exhausting for your doctor to be antagonized at literally every turn and while you might think, “who cares?”, your doctor is going to dismiss you from the practice or, as PP said, start ordering a zillion tests and say “take your pick, do any of these that you’d like” even though that’s against their better medical judgment. If you don’t trust their medical judgment, why not just move on to someone else??

There can be a back and forth. A conversation. That does not mean you don’t trust your doctor, rather you want to be sure you agree with what she is recommending.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Doctors really only fire patients for what they believe is a liability to their malpractice insurance. But I could see how questions could be seen as threatening by some doctors.

It's broader than that. My husband's gastroenterology practice, for instance, fires patients who have their screening colonoscopies done by another practice. That's one of the most profitable things they do, so they don't want patients that go elsewhere for those.

Wow, so much for the doctor patient relationship. I guess he sees them as future billing opportunities. Kind of gross.

It’s a business, isn’t it? If the doctor patient relationship was so special and sacred why would you even be going to a different doctor for your colonoscopy? Oh, because it was more convenient or less expensive? But what about the special doctor patient relationship you have with your gastro???

DP.

This is the problem. Some people (not all, and not even many, I think) want to insist that the doctor-patient relationship is not one with any special connotation or status. It's just like any other business, right? But then they *also* want it to be a special relationship that comes with extra obligations -- but only on the doctor. The doctor has to do additional work outside office hours for free, spend uncompensated time (not ten minutes, but over an hour) doing special research on topics or perspectives outside the standard scope of care for their practice, not react to being criticized or challenged as not being good at your job to their face, remain calm in the face of emotional, angry, and/or aggressive patients, and put their license at risk to delicately step around special idiosyncratic concerns about vaccines or masks or my child being special or I know my own body which means I also know all of he field of medicine and so on and so on.

You can't hold both perspectives at once. Either it is, or it isn't. When you insist on the one, you reject the other.

As for me and the people I trained with, we took on this job and its training with the expectation that it was not just a business and there *were* special obligations. But if a given person is going to salt the earth insisting it isn't, then, well, it isn't. Not for that person, as it's obviously not the relationship they are willing to engage in. But then there are not special obligations on me, and if I am *also* not helping them, I will gently but firmly disengage and wish them well.

That's not thin skin. It's not unprofessional. It is eminently practical and respectful of the stated wishes of the patient.

Doctors tend to “fire” patients for multiple no shows, or non adherence. Not necessarily garden variety non adherence like “I stopped taking the Flovent because I felt better, now I’m wondering why I’m coughing again?” Or “I never scheduled the X-ray because I got busy and my back was feeling a little better anyways”. I’m talking like, refusing a diagnostic work up or refusing to try medication X before moving on to medication Y despite medication X being a safer choice for the patient. That’s fine if you don’t want to start with medication X but I can’t in good conscience prescribe you medication Y without at least trying something safer first. So if your only goal is to get prescribed medication Y, as opposed to work with me to try to get to the bottom of your symptoms, then yeah, you should go elsewhere to someone who will just prescribe medication Y without further work up. And since some patients “do their research” before coming to see me , I get a lot of patients like this, that have a treatment plan in mind and don’t want to hear anything else about it. Fine, but you can’t just buy a prescription from me with your copay, my license is on the line here.

Anonymous wrote:Not the OPs question, but it baffles me that people go into a doctors office for a first visit with the mind frame that the doctor is going to try to harm them. Do you also meet with your child’s teacher with the mind frame “this woman is going to try to make my child hate school unless I beat her into submission during our first meeting”.

As I typed that I realized that yes, some people actually do do this I think. What an exhausting way to live.

Exactly. But they are on the side of right and are “informed” and only seek guidance they may or may not follow. Sounds like a great way to waste a massive amount of energy instead of actually living like a normal person.