WHAT’S HAPPENING IN MEDICINE

Are you the kind of patient who drives doctors to an early grave?

SIDNEY KATZ May 1 1969

WHAT’S HAPPENING IN MEDICINE

Are you the kind of patient who drives doctors to an early grave?

SIDNEY KATZ May 1 1969

WHAT’S HAPPENING IN MEDICINE

SIDNEY KATZ

Are you the kind of patient who drives doctors to an early grave?

WAS THERE EVER a time when so many unkind things were being said about the family doctor? I doubt it. In the headlines and the letters columns of our newspapers, he's under attack — for not making house calls, for not responding to “emergencies,” for rushing through appointments. The underlying reasons for some of the complaints — the facts that medical insurance has enabled almost everyone to afford the doctor’s services and that only half of the graduates produced by our medical schools today become general practitioners — don’t inhibit the critics. All they know is that they couldn’t get service when they wanted it. Or they didn't like the service they got. Or they thought it cost them too much. They blame the doctor.

There had to be another side to the familiar story of the negligent GP and the imposed-upon patient, and 1 sought it from Rodger Whitman, a 50-year-old physician in general practice in Seaforth, Ontario. I chose him because of the variety of his experience: he has practised for 20 years in both urban and rural communities and he has served as assistant director of the College of Family Physicians of Canada.

Whitman believes that selfish, unreasonable. irritating and demanding patients have helped to send many a gen eral practitioner to an early grave, “I recently looked through the obituaries of 34 Canadian doctors,” he said. “The ages at death are chilling: 28, 33, 43. 47, 48. 50 and 56. How many of these deaths are the result of the unnecessary pressure and stress of practice today?”

He identifies seven types of patients who make a doctor’s life tough:

THOUGHTLESS PATIENTS: They make unnecessary calls for help, late at night or on Sundays or holidays. One man phoned at 3.30 a.m. He had been warming the baby’s bottle. He wondered why the doctor had not prescribed a less-expensive formula. Another had a chronic cough for four weeks. Then he insisted on a house call, although the condition had not stopped him working regularly.

KNOW-IT-ALL PATIENT: TO hear this fellow talk, you’d think he had a string of medical degrees. Inside the consultation room, he lists his symptoms and gives the diagnosis and throws in a few medical terms, usually misusing them. Whitman observes: “He’s all muddled up after misreading a few medical articles. When I assure him, after a careful examination, that his self-diagnosis was wrong, he argues with me.”

BIG-SHOT PATIENT: This man regards himself as highly privileged. At whatever hour he calls, he expects the doctor to come running. If he deigns to make an office visit, he feels rebuffed if the

doctor doesn’t drop everything and see him at once.

TELEPHONE PATIENT: He finds the telephone so wonderful that he refuses to visit the doctor’s office when he’s sick. Why can’t the doctor tell him what’s wrong on the phone? “Diagnosis by phone is bad medicine and can be dangerous medicine,” says Whitman. “We can’t depend exclusively on what the patient tells us about his condition. He may leave out the most telling clues.”

DISOBEDIENT PATIENT: He takes the time and trouble to undergo a complete medical examination, listens to the doctor’s advice, buys the drugs prescribed — and then he does nothing. Studies have shown that the majority of diabetics do not practise good diabetic control; that one out of three patients with nervous disorders don’t take their antidepressant or tranquilizer pills regularly and that most mothers can’t be depended on to give penicillin to their children for the full 10-day course of treatment. Fat people are the worst offenders. “They insist that they’re starving on the diet you prescribed and then they show up, having gained weight,” says Whitman.

BEAT-AROUND-THE-BUSH PATIENT: He

wastes the doctor’s time by a lack of honesty and directness in describing his problem. If he’s an alcoholic, he’ll complain about digestion. If he’s having sexual difficulties, he’ll refer to pains in his pelvic region.

SWITCHING PATIENTS: They like variety in doctors and will seldom stay with one practitioner for more than a brief period. “I know of one patient who tried eight different doctors in two months,” says Whitman. “The patient who keeps shopping around is not likely to receive good medical care. No single physician has the opportunity to observe him long enough to understand his condition.” □