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Saudi Journal of Kidney Diseases and Transplantation
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DOCTORS DIARY Table of Contents   
Year : 2006  |  Volume : 17  |  Issue : 4  |  Page : 586-588
Why Patients Get Upset by their Doctors


Division of Nephrology, Hypertension and Renal Transplantation, King Abdulaziz Medical City, Riyadh, Saudi Arabia

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How to cite this article:
Al-Sayyari AA. Why Patients Get Upset by their Doctors. Saudi J Kidney Dis Transpl 2006;17:586-8

How to cite this URL:
Al-Sayyari AA. Why Patients Get Upset by their Doctors. Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2019 Nov 18];17:586-8. Available from: http://www.sjkdt.org/text.asp?2006/17/4/586/32503
Doctors go through a number of stressing situations. To me one prominent stressful situation has to do with confrontations with a patient or his relatives. It may feel to the doctor that the patient or his relatives are to blame when in fact the doctor is always at least partly to blame. I feel that many of such upsetting situations can be avoided or at least minimized by the doctor. I will address some ways that helped me personally a bit later.

I have learnt early on in my career that there are patients whom I like and those who frankly I do not much like for a variety of reasons. This probably applies to the majority if not all doctors. I have learnt with time to prepare myself mentally to be calm, and indeed sympathetic, when I see a patient I have grown to "dislike".

It, also, helps a doctor to analyze why he does not like a specific patient, or why a confrontation occurred between him and a patient. This way he may come to the conclu­sion that the fault lies at his own personal handling of a given situation or his won insecurity. Once this is realized he may then put into action mechanisms o reduce tension between him and the patient. This may also enable to the physician to teach himself coping mechanisms to deal with patient-doctor stresses. Let me give a personal example. I found that I tended to get upset by patients when they demand more time from me than I felt appropriate during ward rounds (this, incidentally is also a common reason for patients to get upset with their doctors i.e. that their doctors do not give them enough time). I found that it helps in this to.

I try to predict what they want to know and tell them before they ask. This is generally easy because patients, generally, want to know 3 things: results of tests done since the last ward round, how they are progressing and what are the treatment plans.

I sit down during ward rounds than remain standing up and draw a chair next to the bed. This makes one "less remote" and in addition it implies one is not in a hurry. To the patient five minutes while sitting feels like 10 minutes standing.

I discuss the case by the patient bedside rather than before. It helps the patient realize that doctors are seriously spending some reasonable time discussing his case.

Soon after I became a consultant, I had following argument with a relative of a 60­year-old gentleman.

The relative: So you don't think the kidney is the cause of my father's pain I: I am definite of this as I told numerous times. This is probably nothing The relative: The pain is bothering my father day and night and you say it is still "nothing"

I: I meant it is nothing serious

The relative: How can you be sure of this?

I: I know because I know what I am expert on. I am a nephrologist for God's sake The relative: I have heard that there is a type of X-ray called CT scan. Why don't you do this?

I: Look I told you there is nothing wrong with your father's kidneys An Ultrasound examination has already been done and it is OK

The relative: But I spoke to a doctor relative of mine working in St Elsewhere Hospital who told me that my father needs a CT scan to rule out kidney disease I: Then you better take your father to this doctor. Good-bye

This illustrates typical situations that often lead to doctor patient confrontations. We are piqued when a patient or a relative are deemed argumentative as in this case. We as doctors may get upset if we feel that our professional competence is being questioned. In the above example I was clearly unhappy that I was told what other doctors think as it contradicted what I thought t. I was further upset that the relative suggested an investi­gation I didn't think necessary. I ended our discussion in a negative way because I got myself upset unnecessarily.

Now with a bit more experience in hand­ling situations behind me the discussion would have gone something like this.

The relative: So you don't think the kidney is the cause of my father's pain I: It is most unlikely that the pain is from the kidney. Usually pain arising from he kidney has different locations and often associated with other urinary symptoms, which your father does not have. What I am sure about is that your father does not have a serious condition but I do believe he does suffer from pain.

The relative: The pain is bothering my father day and night though I: I will prescribe him something for this

The relative: I have heard that there is a type of X-ray called CT scan. Why don't you do this?

I: This is something we can think about if the symptoms don't settle or if new symptoms arise, like urinary symptoms I mentioned above. This examination may involve injecting a dye into your father, which could cause kidney problems. And as you know your father had an ultrasound examination which was normal

The relative: But I spoke to a doctor relative of mine working in St Elsewhere Hospital who told me that my father needs a CT scan to rule out kidney disease

I: It is possible that the doctor did not have all the information that I have about your father's condition. But he can call me to discuss the case.

In this take of hypothetical discussion, I was less confrontational. I explained things in simple terms. I explained more. I was happy to accept that I may be wrong. All these aspects relieve tension and reduce conformation between doctors and patient. Some doctors tend to mystify medicine to their patients. I suppose this makes them feel special and knowledgeable. This does not help. Besides being irked by what they perceive as ques­tioning their professionalism, doctors also, get upset if the patients or their relatives are ungrateful according to the doctors' views. An example of this is if the doctor has been looking after a patient for many long years only to be complained about after all these long years about something apparently feeble. This can be upsetting, I am sure. One way of guarding oneself against is that doctors should view their vocation as serving the patient and should not expect gratitude in return.

The level of expectation of the ability of Modern Medicine in reaching a diagnosis and providing curative treatment can some­times be unrealistically high on the part of the patients and their relatives. This can also lead to frustration, which sometimes is dire­cted at the doctors. We all heard comments like "I have been in for 10 days with this fever and you still tell me you don't know what the cause is, after all the investigations I have been through? Surely that can't be right." Or "Surely you can do something about this stoke which has debilitated my grand­father. He is not getting any better, although the stoke happened three months ago".

I found it helps if you were frank and trans­plant yet empathic upfront with the relatives from the word go. Keep them in the loop always. This really does work although not 100% of the time. I must admit.

I recommend to my junior staff to watch a film called "The Doctor" starring. William Hurt This was about a very successful savvy surgeon who got it all until he developed throat cancer and started seeing things from the patients' point of view. He came to appreciate empathy in doctors he previously thought dull and boring before the onset of his calamity and learnt much about sleazy doctors. I recom­mend that you see it.

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Correspondence Address:
Abdulla A Al-Sayyari
Division of Nephrology, Hypertension and Renal Transplantation, King Abdulaziz Medical City, Riyadh
Saudi Arabia
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PMID: 17186700

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