Patients Are Crazy

.. or at least one of the people I follow on Twitter says we patients are crazy.  You can see his post here:

peoplearecrazy

My reply to him was that he shouldn’t be so surprised that a patient wants to review a second opinion.  Let’s look at point of view:

Suppose your car is making a horrible noise.  You take it to the mechanic who tells you your engine needs to be replaced.  Knowing what that will cost, not to mention that fact that it means your car will be out of commission for — oh — three weeks — while the engine is replaced, you take it to a second mechanic.

The second mechanic tells you that you don’t need a new engine.  You really only need to replace the belts.  That will cost you (money, time, grief) only a fraction of what replacing the engine will cost.

Now what? What if Mechanic #1 is right?  But, what if Mechanic #2 is right?  How are you supposed to know?  Do you need a third opinion?

If you trust Mechanic #1 (because, remember, trust and the expectation that he is 100% right 100% of the time are two different things) then it requires a further conversation with Mechanic #1. You need to know why he’s recommending the engine be replaced and why he doesn’t  think simple replacement of the belts is enough. You have additional questions, and you are confident Mechanic #1 can answer them.

And that is what your patients want to know.  They need a way to compare the two opinions they have received.  They need to know how you arrived at your recommendation. If they return to you, they do so because they trust you.  They just need to understand it better.

Put another way — what if it was you or your child? What if you had a difficult decision to make that would affect your child’s health and two people had told you two different things.  How are you supposed to figure out all the important details?

Patients aren’t crazy — they just don’t know the protocol.  They don’t understand reimbursements.  They don’t understand that you can only bill them if they show up in the office for the conversation.  They don’t get that you aren’t interested in donating your time to them.

But if you treat them as if they are crazy, they will never get it.

How to get beyond that hump?  Invite them in to discuss — through a billable appointment.

Your patient needs only a simple explanation.  “Mrs. Jones.  Dr. FirstOpinion would be happy to discuss this with you, but we’ll need to make an appointment to do that. Can you come in Thursday at 2 PM?”  Then, when Mrs. Jones arrives, explain to her that her payer requires an appointment be made to discuss options.  If she is puzzled, explain how reimbursement works.

We patients need all the information we can get.  And we need your respect for our information gathering efforts.  We want to collaborate with you, looking to you as our #1 resource for the information that will help us make difficult medical decisions.

Patients aren’t crazy.  We just need to learn. And we want to learn from people we trust.  Like you.

*Note:  Please see PediatricInc’s response to this post

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Learn more about Trisha and her work.

Learn more about Trisha’s book
You Bet Your Life! The 10 Mistakes Every Patient Makes

(How to Fix Them to Get the Healthcare You Deserve)

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  1. Brandon
    July 14, 2009 at 2:28 am

    Hello readers of Trisha’s blog,

    This is @PediatricInc. Trisha called me out, so I’m going to explain the thoughts that prompted my tweet in an effort to (hopefully) clear up some of the misconceptions Trisha’s post might have given you.

    For the record, we don’t have a problem with patients trying to understand as much as they can about their children’s health. To imply I don’t understand a patient’s need to learn as much as they can about their condition is silly. C’mon, give me/us the benefit of the doubt.

    The patient in question, however, was not trying to compare notes, or gather information or wanting to learn more as Trisha incorrectly concluded.

    This patient disregarded one of my doc’s advice (and other doctors as well) and decided to get another opinion. Now, going for a second opinion is not the issue. Not trusting the doctor is not the issue either.

    The issue is this, if a patient disregards a doctor’s advice and decides to get a second opinion, we frown upon the patient coming back to the doctor (they ignored in the first place) to discuss her opinion’s about the advice the second doctor gave the patient.

    Again, just to be clear, we don’t have a problem with the patient seeking information, asking questions, probing and challenging the doctors. Likewise, we don’t have a problem with patients seeking second opinions.

    But, if the patient doesn’t trust the doctor’s advice, don’t ask the same doctor what she thinks about another doctor’s advice. You are going to annoy her.

    It is like saying, “…I don’t respect your professional opinion regarding my child’s condition by disregarding your advice, but let’s chat later, I want to ask you, your opinion on what this other doctor had to say.”

    You can’t expect the physician to not get annoyed with that. Hence my tweet.

    Lastly, I do believe people are crazy. If you think I’m crazy for saying this, ask anybody that works with the general public (healthcare, retail, restaurant, hospitality, airlines, and on) about customer encounters. Each of them can tell you funny stories about how crazy people are. And yes, patients too.

  2. July 14, 2009 at 7:21 am

    Brandon,

    I still need to clarify something — here’s my question:

    If I go to another doctor, does that mean (in your opinion) that I have ignored the first opinion doctor? Do you consider I have disregarded the first doc’s advice?

  3. July 14, 2009 at 4:31 pm

    I guess right at the moment, I am interested in how exactly it is known that the patient does not trust doctor #1?

    After that is known, I have more that I will share either here or on my own blog.

    At the moment, Brandon your comment seems contradictory the way that I understand it. Looking for a little further clarification, of course without going into too much detail regarding the patient.

  4. July 15, 2009 at 1:13 am

    Although I don’t know the specifics of the case I will comment.Whatever decision the parent makes about the care for their child, it will be a decision they will have to live with for the rest of their life. I see nothing wrong with getting other opinions and then going back to the doctor and discussing it further, even if they are not taking the advice of the dr. Without going into great detail, I cared for a son who died of krabbes disease, a 24yo brother who died of avelolar cell lung cancer, my mom who survived a radical masectomy in1974 & in 2004 died of Ovarian cancer, .My mom also had cataracts,detached retina, uvitis, gallbladder removed, and a bullet removed.She was hit by a stray bullett during a robbery.MY father died of lung cancer in 2005.He survived a stroke, had a triple bypass, and was hospitalized for a hernia. I was one of the major caretakers for everyone. My family doctor always was willing to support whatever decision my family made, even if it was not what he originally recommended. If another doctor is recommending a different course of treatment, why aren’t you exploring that option. Sounds like you are saying it is my way or the highway.
    Sorry but I don’t think you have the patients best interests at heart

    • Brandon
      July 17, 2009 at 12:25 am

      Grace,

      One can draw many examples or create conditional circumstances and say, well, what about this and what about that or what if this or what if that. I’m sure in some circumstances I would probably agree it would be OK to go back to the doctor and ask his opinion. It usually is not black or white. So I would never say it is my way or the highway because each situation is completely different.

      I think it goes back to the relationship one has with the doctor and perhaps I might have overlooked that aspect, which your comment made me notice.

      If one has a good relationship with their doctor and there is mutual respect, then the issues can be looked at completely different. In fact, there might even be disagreements between the doc and the patient, but if there is a solid, trustworthy relationship, each side will work together under any circumstance.

      Perhaps the main issue with the patient I’m referring too (the one I tweeted about) is that there was not a pleasant patient/doc relationship. In my opinion, the doctor reached out (as they always do) multiple times, but the patient didn’t reciprocate.

      Thus, found it “crazy” that this patient would be so bold to continue asking for advice when in fact she made it clear there wasn’t a trustworthy doc/patient relationship.

      (for the record, the doctor did take the patient’s call – during the doc’s lunch break – and patiently went over her recommendation and discussed at length what doctor #2 had recommended for the patient).

      Thanks for sharing a small portion of your story. I can only imagine what something like that would be like.

      @PediatricInc

  5. Brandon
    July 16, 2009 at 11:56 pm

    Trisha,

    Regarding your question if a patient goes to another doctor, does that constitute disregarding the doctor’s advice, and the answer is: of course not! Just because you went to get another opinion doesn’t mean you are disregarding a doctor’s advice.

    One example disregarding the doctor’s advice to me is going against the doctor’s clinical recommendation for treatment. In other words the patient is non-compliant, hence the disregard.

    However, patients do get second opinions because they don’t trust the doctor. In this particular case (the one I tweeted about), the patient did not trust the doctor’s advice.

    Again, I’m not taking issue with the patient not trusting the doctor or getting the second opinion. Of course one can disagree with a doctor’s point of view or go where ever we want.

    But I think it is foolish and totally unsound to go back to doctor #1 (whom you’ve disagreed with and don’t trust) and ask him for advice about what doctor #2 said.

    Why would you continue to ask for someone’s advice when you’ve made it apparent you don’t trust that person’s advice?

    In my opinion, as a medical administrator that works with patients day in and day out and as a patient (yes, I’m a patient too, with children that have also been patients I might add) I think that is of poor sense.

    I say move on, find someone you do trust, take responsibility for your actions and don’t continue asking for more advice when you’ve already disregarded all the advice they’ve given you.

    What more can I say?

    @PediatricInc

  6. July 17, 2009 at 8:21 am

    Brandon,

    Here’s something we wholeheartedly agree on — the entire question is based on trust.

    I doubt you know why I do the work I do – it’s because 5 years ago this week I was diagnosed with a rare and deadly lymphoma and told I had only months to live. I was then told I needed to begin chemo immediately so I could add an extra year to my life.

    The very arrogant oncologist who delivered that death sentence to me also had a FIT when I went for a second opinion. To say I didn’t trust him was an understatement.

    Yet — I did go for a second opinion and was told that chemo would not be the right answer for me. Instead, radiation was recommended. This doctor was very trustworthy, an excellent partner to me. I did trust him.

    But trustworthiness and medical skills are two different things. And when you’ve gotten two very differing opinions from two people who presumably know what they are doing, you can’t simply default to the person you like and trust better! It was incumbent upon me to return to the first oncologist, despite the fact that I didn’t trust him, despite the fact that I really did not like him, despite the fact that he was an arrogant SOB — I had to go back to him to measure my two opinions. Only HE could answer my questions.

    Put another way — if I didn’t go back to the first one, just WHO was supposed to give me the life and death answers I needed? I was very much the non-compliant patient by then…. and you’re right — I didn’t trust him.

    So, granted, sometimes patients can be trying, can be non-compliant, and don’t trust. But help me understand how it is we are supposed to compare two very differing opinions?

    The end of my story will make your hair stand on end,by the way.

  7. July 17, 2009 at 11:53 am

    Brandon
    Thank you for taking the time out to respond and clarify the situation. As a mother, the claws come out when it comes to advocating for children. I do know that there are doctors who do not do the research.I have had my share of negative experiences but I agree that I would not go back to that doctor just to try and prove him wrong. I would however let the doctor know if I had learned some new information that he was not aware of.

    Grace

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