One of my all-time favorite physician bloggers, Dr. Jordan Grumet, is making a big career change, and he wondered this week how many of his patients will be loyal enough to follow him to his new practice.
He’s learned from experience that some won’t – John, for instance, who arrived in his office several years ago with a cancer that had been missed on a CT scan. Dr. Grumet pursued the diagnosis, John was successfully treated and they had a doctor-patient relationship that lasted for several years, until Dr. Grumet moved to an office half an hour away and John declined to follow him.
“Without apology, he explained that he preferred someone closer,” Dr. Grumet wrote.
And yes, it hurt, he admits. “My sense of professional worth dropped a notch that day.”
Patients leave their doctors for many reasons, not all of them personal. Sometimes it’s because the doctor is no longer in their health plan network. Sometimes the patient or the doctor moves to a new location and the distance is too far, or transferring the medical record is an unwanted headache.
Other times it does become personal – when patient and doctor clash over a decision, perhaps, or a negative experience prompts the patient to bail out.
No matter the reason, however, it can be emotionally painful for a doctor to be dumped by one of his or her patients.
Somewhat surprisingly, this issue and its impact on the physician’s psyche have been little studied. One of the few pieces of research to date comes from Israel and contains a couple of interesting findings: Doctors were more likely to experience hurt feelings when the relationship was terminated by someone who had been their patient for a long time. It also hurt more when the patient was perceived to be someone of high social status.
The researchers came to these conclusions after asking 119 Israeli doctors to respond to four fictional scenarios involving a patient who switches doctors. As part of the study, the doctors also were invited to share their own experiences and reactions to being dumped by a patient.
Why would it hurt more if someone who had been your patient for many years decided to change doctors? Physicians feel vested in a relationship of many years’ standing, and a patient who comes back year after year is usually sending a signal that he or she feels vested too, the study’s authors wrote:
Thus, physicians may expect that patients will not end long standing relations for trivial reasons but rather that something serious has happened such as gross dissatisfaction with the treatment, or other serious reasons for extremely negative evaluation of the physician’s competence or behavior. Such thoughts would engender a heightened sense of relational devaluation and hence a higher level of hurt feelings.
That physicians also would be more bothered by the departure of a high-status patient is one of the more intriguing findings of the study. The researchers hypothesized that doctors may assume, correctly or not, that patients who are educated, well off and of good social standing are also better judges of the doctor’s professional competence and therefore more likely to have opinions worth valuing.
The personal stories shared by some of the doctors in the study revealed more nuances. Several of them described feeling hurt at investing great time and effort in a patient’s care, only to have the patient change doctors. One doctor had an entire family leave his practice over a single incident of missing a child’s ear infection; what made it hurt more was not being given a chance to explain. Notably, many of the doctors didn’t learn of the patient’s departure until after the fact.
Should it matter if a doctor’s feelings are hurt when a patient leaves?
These situations aren’t without consequences, the researchers wrote. They can lower the doctor’s self-esteem, accelerate the likelihood of burnout and perhaps spill over into relationships with other patients. Moreover, with increasing emphasis on patient-centered care, the doctor-patient relationship has become much more important and there’s greater pressure on doctors to earn the trust and satisfaction of their patients.
Patients don’t benefit by staying with a doctor when the relationship doesn’t work well or when it breaks down. But it may have an impact on the doctor when they bail out, especially if their departure is unexpected or ungracious. At its heart, medicine is still very much about interactions between human beings, the doctor as well as the patient.