When the patient becomes the doctor’s caretaker

In a video interview, the anonymous doctor’s frustration comes through loud and clear. She takes care of complex patients with many health needs, often working 11 or 12 hours a day, sacrificing time with her family. Yet the message she constantly gets from administrators is that she’s “dumb and inefficient” if she can’t crank patients through the system every 15 minutes.

In a word, she’s abused.

And patients ought to care enough about their doctors to ask them if they’re being abused, according to Dr. Pamela Wible, who raised the issue recently on her blog. “The life you save may save you,” wrote Dr. Wible, a primary care doctor on the West Coast who established her own version of the ideal medical practice after becoming burned-out by the corporate model of care.

This is one of those issues that’s like lifting a corner of the forbidden curtain. Many patients probably don’t think too much about their doctor’s challenges and frustrations. After all, physicians are paid more than enough to compensate for any workplace frustration, aren’t they? Isn’t this what they signed up for?

The problem with this kind of thinking is that it ignores reality. Medicine, especially primary care, has become a difficult, high-pressure environment to be in. One study, for example, that tracked the daily routine at a private practice found the physicians saw an average of 18 patients a day, made 23.7 phone calls, received 16.8 emails, processed 12.1 prescription refills and reviewed 19.5 laboratory reports, 11.1 imaging reports and 13.9 consultation reports.

And when physicians are overloaded, unhappy and feel taken advantage of, it tends to be only a matter of time before it spills over into how they interact with their patients.

The million-dollar question here is whether patients can – or should – do anything about it.

Dr. Wible advocates taking a “just ask” approach. Compassion and advocacy by patients for their doctors can accomplish far more than most people think, she says.

One of her blog readers agreed, saying the pressures “must frustrate them beyond endurance. I’m going to start asking.”

Another commenter sounded a note of caution, though: “I feel there is a risk for a patient to ask such a question to a dr. who might be hiding how very fragile he/she is.”

More doubts were voiced at Kevin MD, where Dr. Wible’s blog entry was cross-posted this week. A sample:

– “Abused is a very emotionally loaded word that brings up powerful emotions and feelings like shame. I think if a doc is asked by a patient whether he/she is abused, they might actually end up feeling accused.”

–  “I’m having a hard time imagining most docs responding well to their patients asking them if they are abused and I doubt that most docs would respond ‘yes, I am being abused’ to patients who do ask that no matter what was going on in their workplace. Nor do I think most patients want to spend a big chunk of their doctor visit talking about the doctor’s problems and issues.”

– “And what could I do if the answer is ‘yes’?”

I’m not sure what to think. At its core, health care is a transaction between human beings that becomes most healing when all the parties are able to recognize each other’s humanity.

Yet reams have been written about doctor-patient boundaries and the hazards of too much self-disclosure by the physician. Can it ultimately damage the relationship if the doctor shows vulnerability or emotional neediness? What are the ethics of a role reversal that puts the patient in the position of being caretaker to the doctor?

What do readers think? I’d like to know.

2 thoughts on “When the patient becomes the doctor’s caretaker

  1. I personally don’t see any problem with knowing whether or not your care provider is overworked, stressed, or dealing with some heavy issues. It’s human. But I’m not sure the right time to address those are in the exam room. On one hand, providers are providing a service to patients — the service of addressing the patient’s health concerns/needs. Often, especially considering some of the lengthy wait times patients have to deal with, patients are on a tight schedule that doesn’t allow for anything more than what was planned.
    On another hand, patients, providers, and health institutions at large would all agree that it’s extremely unprofessional to “complain” about work problems to patients. From a patient’s perspective, that might lead to some distrust; if a provider is willing to talk about all the horrible stressful things he/she has to deal with as a part of their job, how likely are they to talk about that patient’s particular issues with people who have no business knowing?
    I think the best way to advocate for and support health care providers is for patients to address the issues directly with the employer. Demand more staff to ease the load. Set up support groups. Advocate for in-house free counseling for providers. But asking a patient to ask about a provider’s issues during the patient’s exam time is too much, in my opinion. It’s already a vulnerable place for patients, and it’s time they pay to have spent on them.

  2. Your post is, as per your norm, right on target. “Abuse” is prevalent in healthcare and is manifest by burnout, disruptive behavior, and leaving positions or even careers. I agree with Katie, though, that the best time to address this is not in the exam room. Most likely, the healthcare professional has a backlog of things that need to be done, and often a waiting room with other patients. Also, it’s not a role that physicians or nurses assume well – that of the patient. Perhaps that’s part of the problem.

    Potential solutions do abound, though. As work-life balance becomes an expectation with the changing generations of professionals, and especially with their spouses, implementation of some solution will be required to maintain the high level of access (and, hopefully, quality care) we enjoy. Lay or public Board members or committee members or meeting attendees can and should ask about productivity standards and about how things are really done. These leaders should “round” in hospitals and clinics outside the exam room to really understand the stresses and what can be done to help. But mostly, the public should adjust their expectations and realize that health care providers (physicians, nurses, and the rest of the team) are human

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