Patient Bullying

Written by on June 4, 2012 in Features - No comments
Patient Bullying

By Paula Rapp

A young friend of mine recently experienced minor chest pain. Not the kind that made her want to call 911 immediately, but worrisome enough to land her before a triage nurse at the local emergency room reviewing her symptoms. The patient, a nurse herself, was promptly seen by the ER physician and after completing the requisite battery of chest pain examinations and blood work was discharged. The tests ruled out a heart attack and she was told to follow-up with her primary physician to determine other possible causes of the discomfort.

Patient Bullying

Patient Bullying

Of course as the pain persisted, she did what any well-informed health care consumer would do, she Googled the symptoms to find out what was ailing her. Within several clicks, she found the elusive diagnosis of which the ER doctor failed to provide: costochondritis, inflammation of the cartilage in the chest wall that can cause pain during breathing.  Dutifully, she followed-up with her primary doctor and proclaimed the diagnosis within minutes of their interaction. Silently she scoffed at the need for further testing that included x-rays, echocardiograms and blood work, and (although she politely listened to the recommendations) she left with what she had gone to receive: a prescription in hand for pain relief. When the symptoms eventually faded, she felt reassured that her diagnosis had been correct and was relieved not to have been subject to a further battery of tests.

The traditional doctor-patient relationship is central to the practice of medicine and cornerstone to a therapeutic bedside interaction. The quality of this intricate bond is based on shared trust, mutual respect and knowledge. If these qualities exist, the doctor and patient will be able to communicate clearly and will likely lead to a more accurate diagnosis and outcome. If this relationship is poor however, and either party distrusts the other’s judgment, decreased compliance with the treatment will often occur. Decreased compliance leads to frustration, aggravation and further erosion of the relationship.

There is another phenomenon however, emerging in the doctor-patient relationship: patient bullying.  This is not to suggest a physical or name-calling type of bullying but rather a more passive, subliminal form. In light of the Internet era, it has become easier to instantly review symptoms and self diagnose, thereby making the doctor seem more of a “middleman,” rather than the voice of diagnosis determination. The situation is often exacerbated by the fact that that the doctor has limited time with each patient and will often comply with a patient’s strong request.

The doctor’s knowledge and experience has been demystified by the age of modern technology.  Patients present to their doctor’s office with the expectation of the antibiotic prescription or the desired test or the clinical trial referral and often won’t relent until their “demands” are upheld. If these requests are ignored, patients feel as if they are being slighted or their symptoms minimized – all before the stethoscope has heard its first heartbeat.

Patient bullying behavior is seldom aggressive in nature; in fact it is often so subtle that it may seem more like the patient is just taking an active role in their own health care. After all, patients are indeed savvier when it comes to their health and want to showcase to their doctor that they also have some medical insight. However, this type of rapport can become toxic when the patient’s strong arm requests outweigh the physician’s judgment.

A population of educated and interactive patients would certainly be ideal, but some of these behaviors may lead to over-demanding patients. The goal of patient education is to make knowledgeable health care decisions that are evidence-based and – more importantly – considered within a positive, reciprocal patient-doctor partnership.

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