Afraid to Ask More From Your Doctor? Let's All Become Difficult Patients!

You're not alone. Not only that, you have good reason. If you speak up, maybe you'll be labeled a "difficult patient". What does it mean to be a difficult patient? We know what it means to be a difficult child, a child with behavior problems. Not difficult patients. The difficult patient is one who challenges the provider, often by asking "too many" questions or requiring detailed explanations. They take up more time and push their providers to justify their advice. 

Justifications for treatment recommendations often lead to gray areas in medicine. According to Jerome Groopman in How Doctors Think, doctors make treatment decisions based on how and where they were trained. He relates taking the same condition to specialists at equivalent medical centers but on opposite coasts. The recommendations were quite different but when asked why, the response was the same: "It's the way I was trained." That sounds OK until you start thinking about differences in costs and outcomes. Difficult patients ask questions about costs and outcomes, leading providers to feel backed into a corner if they don't have the data at their fingertips. Human nature, being what it is, leads providers to label patients as difficult, rather than focusing on how important these questions really are.

We want our providers to follow treatment guidelines developed by their specialty organizations, such as for asthma and COPD. These guidelines were written to give patients the best outcomes. 

Before your next appointment, do an internet search using your condition and treatment guidelines. See who has developed the guidelines. For example, if you look up pneumonia treatment guidelines, you'll find the American Thoracic Society (ATS). Then when your doctor gives you treatment advice ask, "Is this part of the ATS Guidelines for pneumonia?" It's a shorthand way or telling your provider that you want treatment with the evidence to back it up, rather than simply reflecting where their training took place. It's a respectful way to become difficult and you'll be helping to change medicine into what it ought to be.

I'm a patient advocate and I'm here to help.

(Dale Alexander holds a Certificate in Patient Advocacy from UCLA, a Master's in Medical Humanities from the University of Texas and has thirty years of experience in clinical healthcare, education and management. She may be reached at dale5657@gmail.com or 707.319.5856.)