Thursday, May 17, 2012

Why do I fire patients ?

I enjoy taking care of patients and do my best in order to help them to have a baby. However, there are times when I will criticize my patients. Now I know that this is not something which many doctors commonly do and I would like to explain why I do this.

Whenever I see a patient for the first time, I ask them to interpret their own reports. This gives me a good sense of how much the patient understands about their medical problem and the treatment options. However, many times patients look completely blank and are not able to provide a satisfactory answer. In fact, some of them are completely nonplussed as to why a doctor should be asking the patient these questions. After all , isn't it the doctor’s job to interpret the test reports? Why should a patient be doing this? Are patients even allowed to be doing this ? And does the fact that the doctor is asking the patient to interpret his reports mean that the doctor is clueless and does not know how to do this himself? Could this possibly be the sign of an incompetent doctor ?

Before I start advising my patients, I first need to understand exactly what they understand about their own problem , which is why I ask them these basic questions. However, when they are completely clueless, I do get a little upset because I am concerned that they have spent such little time and energy on trying to make sense of their own problem.

I don't think it's a good idea when patients refuse to apply their own intelligence to solving their own problem . I'm worried about patients who want to leave everything up to the doctor rather than provide intelligent personal inputs.

It is especially when patients justify their ignorance by telling me – “ But how am I supposed to know the answers to these questions “ or, equally commonly, “ My doctor is to blame because he never gave me any of the reports of my IVF treatment cycle “ that I get even more agitated. While it's true that if a patient who cannot understand his medical reports suggests a patient who has received poor medical care ( because his doctor has not bothered to explain the details to him ), it is also equally true that this reflects badly on the patient himself , because he has not taken the time and trouble to do his homework himself. In this day and age, there is no good excuse for an educated patient not to understand more about his medical treatment, because there is so much information online, which is reliabl , updated and easy to understand.

When this happens the first time, I am critical, but I do explain to the patient why it's important that they take an active interest in their treatment. I tell them that it is in their best interests ( as well as mine ), because this ensures they have realistic expectations of exactly what I can do for them.

Patients are not used to being criticized by their doctor on the first consultation, because the doctor is usually on his best behavior at this time, because he wants the patient to come to him for treatment. Intelligent patients understand that I'm doing this in their best interests , so that going forward, we can create a win-win partnership to maximize their chances of success. However, there are some patients who get quite irritated with my criticism and decide that I'm not the right doctor for them. These are patients who decide not to come to me , and find another doctor.

So if I know that my being critical will cause me to lose patients, am I being smart in continuing to do so? Aren’t I being stupid ? Isn’t it better for me to be sweet so that I can get more patients ?

I think doctors get the patients they deserve and patients get the doctors they deserve as well. The chemistry between the doctor and the patient needs to be right , and I prefer treating patients who take an active interest in their treatment and are well-informed , rather than those who couldn't be bothered to do so . This allows me to focus my energies on patients who understand the importance of information therapy , and have the same philosophy as I have. Since I have the luxury of being able to pick and choose my patients, I feel this strategy works well !


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