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    Shining a Mirror on Gripes

    As I was reading through the physician quotes in the recent Medical Economics article, Top 11 gripes physicians have with patients, I had a mental image of my own colleagues and myself saying very similar things over the years.

     

    RELATED: Patients increasingly disrespectful to physicians

     

    Looking inward for solutions to these conflicts, though, has led me to experience more meaningful relationships with the very patients who I once shared these negative thoughts about, along with much greater joy and reward in my practice.

    This breakthrough has come about through focused work on relationship-centered communication skills, and seeking opportunities to be observed and mentored by astute colleagues.

    Although it is the most fundamental of all things that physicians do, communicating has never been a teaching priority in medical school. The result is that we blame patients for our own deficiencies. The gripes seem to fall into some general categories, and I have some thoughts to share about each.

    One set of gripes focused on requests for inappropriate prescriptions or tests. For many of us, the temptation is to shoot down the request with a barrage of facts, which rarely works and often increases the tension in the room. I have been much more successful when I first ask the patient why he thinks this is necessary. What often follows is a story that reveals his fears, concerns and level of understanding, which allows me to address the request with empathy and facts customized to his specific worries.

    Non-compliance is another thorn in our collective side. This may be due to poor health literacy, but it is easier to just assume patients don’t care.

    The use of simple, jargon-free explanation, motivational interviewing and teach-back have been shown to substantially improve adherence. It requires a little more effort, but some of this can be delegated to other members of the care team, encouraging them to be more engaged and work at the top of their licenses. The payoff for patients can be great, and our frustration barometer can take a big drop.

     Rude and entitled behavior may stem from feeling unheard or dismissed, and acknowledging feelings is much more effective than defensiveness. People are often not in their most agreeable state of mind at the doctor’s office—it is rarely a place where anyone wants to be.

     

    RELATED READING: Here's how physicians can combat patient gripes

     

    Physical symptoms, along with a bundle of fears, worries and concerns can do a pretty good job of shutting down reason—most of us have probably been there at one time or another. Going nose to nose with patients who are acting-out is unlikely to lead to a healing place. Some patients may even react to this power struggle by assuming a more passive role in an attempt to be a “good patient,” which can limit the honest history we have to work with.

    Next: Managing expectations and setting agendas

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      We aren't sensitive enough to patient complaints of pain. So the regulators made and still insist on asking patients if they have pain and how bad it is on a scale from 1-10! Then we as physicians are blamed for having prescribed medications that relieved the pain in patient's who are not addicts but genuinely suffering from painful disorders and who have developed the physiological state of dependency where stopping the medicine will generally result in a withdrawal syndrome or the return of the pain for which it was intended in the first place. Those who are exhibiting what is called an addictive behavior are not taking the medication for pain but for a feeling of euphoria that has nothing to do with the relief of pain. The Federal Government believes that by punishing physicians with overwhelming bureaucratic paperwork generally developed by DEEP STATE REGULATORS it can somehow deflect the criticism from itself and thereby insulate itself from blame. The government never blames itself for mistakes it makes. There are always scapegoats aplenty for that purpose. So the government encourages the legalization of marijuana (wasn't it at one time considered to be the doorstep to more dangerous drugs) and in the case of the Obama administration allowing the influx of CDS and illegals from Mexico across the southern border of the US and an influx of cocaine and potential rogue terrorists from entities in league with IRAN from the Middle East so as not to jeopardize the all-important Obama legacy treaty with IRAN that ensures that it will take it's place among the nuclear powers of the world in which we live and ensure Democrat Party rule for years to come. The pressure on physicians to obey or receive reduction in re-imbursements is staggering in the face of these UNFUNDED BUREAUCRATIC MANDATES but it is not limited to CDS alone. Medications that may be helpful in the treatment of pain are being removed from consideration for many reasons including the age of the patient, the duration of their use, and simply because of cost even if the medications are generics and have been used for decades. When patient's don't follow the recommendations of physicians we as physicians are to blame just as teachers are to blame because their pupils fail to learn. These are multifaceted issues for which there is no easy solution as long as the government continues to be removed from the equation.

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