What Makes a Good Patient?

[Guest guest]

From

this weeks Time Magazine

What

Makes a Good Patient?

The

blind, overweight patient in the wheelchair has terrible pain in her back and

burning pain in her legs. She also has advanced arthritis in her knees and

end-stage circulatory disease, which have left her with two useless legs that

are red, swollen and infected. Now her shoulder has started to hurt. She can't

raise her arm to comb her hair. Five or six other things are wrong with

her--she tells me about each. Some we can help; most we can't. I tell her as

much.

In

my office, she listens carefully. I hardly ever have to repeat myself with Doris (not

her real name). She asks questions--mostly good ones. She needs lots of tests,

various therapies. I ultimately recommend an operation on her shoulder. Sick,

weakened by multiple symptoms and with lousy insurance, Doris

is--surprise--a really good patient. She communicates efficiently with her

doctors and treats us with respect and trust. She has reasonable expectations.

I can tell she looks things up, but her knowledge is helpful--never

challenging. I've talked about her with other doctors, and we agree on this:

when you see Doris' name

on your day's list, you know you're going to work hard. But you're usually glad

her name is there.

Few

patients realize how deeply they can affect their doctors. That is a big secret

in medicine--one doctors hate to admit. We think about, talk about, dream about our patients. We went into clinical medicine

because we like dealing on a personal, even intimate level with people who have

chosen to put their bodies in our hands. Our patients make or break our days.

Take

the compliment. Our career choice means we really do think that you--with your

aches and pains--are more interesting than trading hot securities, more fun

than a courtroom full of lawyers. Massaging the ego is the key to manipulating

responsible types like doctors. When we feel your trust, you have us.

The

most compelling reasons to be a good patient are selfish ones. You will get

more than free drug samples if your doctor is comfortable and communicates

easily with you. You'll get more of the mind that you came for, a mind working

better because it's relaxed--recalling and associating freely, more receptive

to small, even subliminal clues. That means better medical care. But you should

try to be a good patient for unselfish reasons too. We worry about you 60 hours

a week. We gave up our 20s for you. Why not show us some love? It's not hard.

The

medical relationship is intrinsically one-sided. It's about you and your

problem. I am going to find out more about you in the next 20 minutes than you

will find out about me. Don't fret about that. We don't expect you to ask much

about us. Good patients answer questions accurately and completely. They ask

questions too.

But

many patients talk too much. You might notice that we are writing when we see

you--we are creating your chart. We need specific facts but not every fact in

your life. Here's a classic exchange:

How

long has your shoulder hurt, Beatrice? " Oh, for quite some time now. "

But for how long? How many months? " Oh, at least

since the wedding--well, then again it did act up a bit when Margaret came back

from Ireland ... "

All

I want to do is write something like " Right shoulder, 6 months, no

trauma " on my chart. Although I lack the heart to tell her, Beatrice would

be a better patient if she tried to be a bit more concise. There are lots of

Beatrices.

Here's

another classic:

" Well,

I don't need to have good manners--I'm sick--and I'm not going to be a patsy

for some smooth talker in a white coat. The squeaky wheel gets the grease, you

know. "

That

is the mind-set of many patients who abuse their doctors; my bet is they abuse

other people as well. Any good doctor knows when you're too sick to be polite

and will let it roll off his back. The squeaky wheel we don't like is the one

playing a dominance game. That big wheel is likely to get a shorter, less

sensitive examination and more tests, and then still more tests to follow up

the abnormalities in the first tests, followed by extra consultations with

specialists--anything to relieve the doctor's responsibility for a bad patient.

Are

doctors good patients? Others may disagree, but I

think they are. Medical jargon doesn't faze them, so communication is easier,

and their expectations tend to be more reasonable. Anyone in medicine is

painfully aware that there are plenty of problems for which we have no good

answer. Nurses tend to be even better patients, being adept at following

doctors' orders--a virtue lacking in doctors.

Doctors

and nurses also know when to respect an educated opinion. When the MRI says one

thing and I want to do another, they are more likely to be on my side. But you

need not be a medical professional, or educated at all, to be a great patient.

It's pretty much the same strain of human decency--a truthful consideration of

who the people around you are and of what they are trying to do--that infects a

good patient and any good person.

Barb

in Texas