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Author Archive: Maurice Bernstein, M.D.

About Maurice Bernstein, M.D.

08/04/2018

Patient Modesty: Volume 90

The animated GIF picture for Volume 90 (thanks to matthen.com via Google images) is my graphicimpression of what has been one of the primary concerns of patients writing here: unwanted, unnecessary or even non-permitted  bodily visual inspection d...

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07/31/2018

Pharmacist:: Just Filling Prescriptions or Should They Also Diagnose?









      There may be some confusion about the full role of the professional pharmacist in medical care. The patient, with
prescription from a physician in hand may consider the 
diagnostic phase completed and comes to the pharmacist for
the prescribed medication to take for their physician identified
illness.  On the other hand, pharmacists after their studies and

But, "Changes to modernize traditional medical education and care delivery are, in fact, currently being introduced, with interdisciplinary health professional teams emerging as a core element of new models. Before graduates of different health programs are assigned practice responsibilities, however, many questions still need to be answered: What are the core functions and responsibilities of practitioners in each profession? What is the minimum education and training needed for someone to attain the core competencies required to perform these functions well and safely? Where do the different professions intersect and where could the public benefit from services offered by more than one provider? How can interprofessional learning and practice environments foster and support collaboration? How can we prevent turf battles and encourage true collaborative, patient-centred, complementary care?"

So, the question to my blog readers is whether, as a patient, you would think that pharmacists should taught further to play the bigger role as diagnostician beyond screening and packing medication already prescribed by the examining physician? Are you satisfied with the relationship you have with your licensed pharmacist? Would you want your pharmacist to learn and carry out more clinical responsibility?  Physicians in the past and occasionally now have dispensed medication to their office patients after making a diagnosis. Should pharmacists take on a bit of the responsibility of making a diagnosis based on their more limited pharmacy school and hospital internship experiences? How do you want your pharmacist to be interacting with you as a patient? ..Maurice. 


 Graphic: From Google Images and NIDDK Image Library.





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07/01/2018

Patient Modesty: Volume 89

I took the above photograph of a "dirty" pond this morning (Descanso Gardens, Southern California) because it struck me as analogous with what is currently being written on this thread about the medical system which we are all experiencing.  Each ...

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06/01/2018

Patient Modesty: Volume 88

So.. based on what has been written in all the previous Volumes of this thread, it appears that a consensus is that the medical system just going "down the drain".  And if so..whose fault? Who should we blame?  And if this analogy is realisti...

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05/06/2018

Patient Modesty: Volume 87









EO, a visitor writing in the Comment section of Volume 86 of this thread title has set the stage for further discussion-- particularly the way male patients are treated within the medical system. I thought his narrative would be appropriate to start this Volume. ..Maurice.

Graphic: My composition using ArtRage and appearing as the graphic on the thread "Order vs Chaos in Medical Practice"


Though I am encouraged that many of the contributors to this blog have become activists as regards affording male clients (patients) the same rights as female clients when it comes to modesty/dignity, I see little hope that the system will change in any broad or meaningful manner. There has been some discussion regarding the corrupt corporate takeover of the make’emsick (medical) industry and how this relates to discriminating against male clients, but until the collusion between Big Pharma, private insurers, federal and state governments, and healthcare providers is truly revealed and 100% amended, there will be no real change on the industry’s part as regards the discrimination against male clients. Like the current swamp in D.C., the make’emsick swamp is just too powerful and entrenched to be brought to justice.

Wow! Thanks, PT, for bringing that incident to our attention, wherein a female hag made fun of a male urology patient’s pain level after a prostatectomy (I can only imagine that type of pain such as having a hysterectomy), called him a wuss, made fun of his career as a marine and other commentating hags told the student nurse to get used to because you’ll be gossiping about your patients like we do! Like you said, patient privacy suffers even more because “it’s attributable to what I call the hate factor, devoid of caring, devoid of advocating.” Most people go into the make’emsick industry for the money (and they think the prestige, but man are they fooling themselves here!). I’m sure hags are making ugly comments about clients about a zillion times a day!

That men would even have to think this way as one contributor has written, BESPEAKS VOLUMES about the abusive foundations of Western medicine: “Men will be afraid to come forward and take their case to its conclusion through the courts of public opinion and the criminal justice system out of fear of seaming weak in front of the world and out of fear of retribution from caregivers against those men currently in treatment.” Wow, that ill male clients are afraid (and justly so!) that caregivers will retaliate is abominable! How can a society accept such sordid scenarios? From the little I’ve had to read, female caregivers, especially the nursing hags, retaliate in many and vicious ways! Here’s just one little, minor example: A hospitalized male client refused the nursing hag’s “offer” of shower help (he was totally ambulatory) and angry she could not attend that peep show, she canceled his dinner! Nice, huh! One male has described hospitals as “humiliation factories” where males are “treated like farm animals.” This is a pretty apt analogy!

Banterings, my friend who was abused just wants to forget – he won’t file anything, and we’ve caught the physician in Medicare fraud – charging thousands for a program he did not attend. As you mentioned, he could file for “conspiracy or obstruction of justice… a criminal complaint,” but he won’t do it. This is a typical scimmer-scammer type of physician who opens tons of offices and stocks them with – I love your terms, PT – PAs (Physician Actors) and NPs ( Nurse Quacktitioners). I’ve done what I can with anonymous reports which I’m sure will go nowhere. Time for other avenues… As one contributor pointed out – that good men do nothing that evil prosper.

Maurice, you ask “WHAT IS IT ABOUT PATIENT MODESTY that has attracted so much interest by visitors and writers for this blog? There are so many other life and death topics throughout this blog and yet with them the number of responses from visitors is relatively trivial (though, to me, they are also important and worthy of responding to) but WHY PATIENT MODESTY leads the way and continues to do so?’ Banterings mentioned “social justice” as a reason, and others have indicated the damage that is rendered to male clients re modesty concerns as an assault on one’s very soul, etc. I must concur with both. However, to the make’emsick industry ( I can no longer even call it the sickcare industry since this past year two friends have suffered terribly at the hands of inept surgeons, one losing permanent vision in one eye and the other losing a leg!) male modesty is of trivial concern at the most. Thus, we must ask – why is this so? It is pure common sense that dictates that same sex or gender concordant care (something about the term is rather a put off – just call it what is in plain speech) should be not even questioned, but rather same sex teams should be automatically assigned to clients and if they wish, then opposite sex or mixed gender teams would be arranged. Others here have written of this. This automatic assignment of same gender would put an end to many modesty violations, and as others have written should be codified into federal law that all facilities, whether hospitals or private clinics (if they accept Medicare/Medicaid payments and who doesn’t!) then Title VII dictates that same gender providers for intimate care is ALWAYS PROVIDED. Man, will the nursing hags be disappointed when they can’t run around to peep at whomever they choose!

So, we’ve seen that all the meaningless platitudes of “we’re all professionals,” “standard of care,” “patient dignity is respected,” – the “fake core ethics” as PT noted - and etc. can be seen as nudging/bullying. Recall the stats on colonoscopies and that scam! Well, I’d like to introduce a term that is bandied about as an excuse for whatever the provider wants to do – EBM (evidence based medicine). It is this term that the make’emsick industry shoves down our throats. TALK ABOUT NUDGING! It was probably John Ioaniddis’ 2005 article in PLOS, “Why Most Published Research Findings Are False,” that really brought the false narratives of EBM into the public arena: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124.

Here’s a quick overall read: https://medium.com/@drjasonfung/the-corruption-of-evidence-based-medicine-killing-for-profit-41f2812b8704

I encourage people to read the latest reports of Big Pharma’s fraud, there’s plenty to read out there, and you’ll wonder why people would take any pharmaceutical after educating yourself of their deceptive practices. One of my “favorites” is the bogus medical journal they created in Australia, which promoted certain new drugs. And, be sure to read about the Rockefellers and how they helped to create the AMA and how many safe and USEFUL alternative therapies and practitioners were run to ground/banned. Rockefeller saw a HUGH opportunity to profit from the pharmaceutical poison model, and not so coincidentally this ugly monopolization occurred at the same time he was monopolizing the oil industry.

And here we are today, the richest nation on the planet with (outside of hellholes such as Syria and others) the worst health outcomes. Hmmmm, why could this be?

One of my major points is that the current foundation of the make’emsick industry is based on giving dangerous poisons (pharma drugs) to supposedly “manage” chronic conditions (all “evidence based” yippy!), and conducts significantly more tests (often harmful!) but look at how low US “health” care ranks among developed nations –one of the lowest in terms of infant mortality, life expectancy, emotional and physical health, etc. and is headed lower! We had been discussing the useless DRE (and PSA) tests and how Albin regards the PSA test. Let’s look a little closer at this example of nudging. One expert cited by Ablin says perhaps half of the urologists in the United States would go bankrupt without the gold rush of prostate-removal surgery that followed the PSA discovery. “When a 50-year-old man went for his yearly physical,” explains Ablin, “he routinely had a PSA test, quite often without his knowledge. The level of his PSA could propel him into the prostate cancer industry . . . the prostate gland is at the epicenter of a worldwide trillion-dollar industry and the PSA test as its kingpin. Think of PSA as oil. If the test were made irrelevant, an industry would crumble. You don’t have to be a conspiracy theorist to grasp what the stakeholders will do to keep this industry booming.” Guys, you may wish to read his book: The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster" by Richard J. Ablin and Ronald Piana. Here’s where I found mention of it: https://nypost.com/2014/03/01/why-the-prostate-cancer-test-is-useless/

So, how to reform a Frankenstein-like industry ruled by Big Pharma whose private, monetary interests are sanctioned and ENFORCED by the state (via the make’emsick industry) and in some arenas are not subject to any usual redress via the legal system? How many men abused by nursing hags have sought justice in a court of law? Not too many, as we have witnessed time and time again, and of course the events that make it to the news most likely reflect 1/10 of 1% of such events. As it appears that most morons go into the make’emsick for the income (and yes we must include female hags that go into it for the viewing of naked males), we return to REL’s line of reasoning, that is, we must attack their money/income just as they attack vulnerable, ill male clients. We see that it is VERY effective to boycott certain companies for needed changes. I must disagree, Maurice, that the abusive events are rare – they are most certainly not! If they were, this blog would not exist! Now this is from some 6 months ago, but here’s a team in Bolivar dancing about mocking a naked male patient on the operating table, here’s one of the links: https://www.mirror.co.uk/news/world-news/doctors-nurses-fired-after-outrageous-10112888

It seems Western “medicine” (vomit) is conducive to patient abuse, no matter the geographical area. And perhaps we must come to the conclusion that the make’emsick industry is but a reflection of a society in steep decline. I do ask this: What is it about Western medicine (as opposed to other systems of medicine) that so objectives clients and is overrun with degenerates, whether nursing hags sexually abusing male clients, doctors’ semen ending up on female colonoscopy patients, or hags stealing hospitalized clients pain meds, etc. etc. ad infinitum?

Now, male clients that value their modesty and want to have the same consideration as female clients have been referred to as outliers. I don’t believe this is true, but the make’emsick industry certainly promotes this incorrect idea. That it does so actually tells us that this industry is well aware of this issue, but desires to hide it by distorting the facts. Besides the obvious sexual urges of many workers, especially the female nurses (humiliation of a male client does make for some great convo in the break room!), that many females in managerial positions responsible for their nursing brigades and the hiring, protect the female nurse and discriminate in yet another way against males by not hiring male nurses - this discrimination is against male clients as well as male nurses. And, that physicians allow their office managers to hire almost all if not all female MAs, techs, etc. informs us that they don’t care about the modesty/dignity of their male clients.

I disagree that modesty violations are not sexual abuse – they certainly are! Like the hags telling a male patient to take off all clothes for an EKG and then being terrible disappointed when they flung open the gown to not being able to peep as underwear were still on or the hag threatening a hospitalized client with having a guard perform a rectal swab – these are sexual abuse incidents! They should be treated as such! One writer mentioned having non-medical groups that serve as watchdogs and this is surely needed!

And PT, thanks for the detailed info on just how non-sterile/filthy operating rooms are. I didn’t even think of the cigarette chemicals invading open wounds and until recently thought that the make’emsick industry was really trying for clean ORs. Call me naïve but I thought the surgical teams changed scrubs between surgeries but instead track everything from the last (perhaps infected) surgical client to germs from the cafeteria and cigarette chemicals and the effluvia from a flushing toilet to the next surgical victim (client)!

Sorry, but I think I am extremely disappointed (yeah, okay, angry) that so many male clients won’t speak up for themselves, but will accept this situation. However, a recent poll by Anthem shows at least 60% of males will not return to a female provider after seeing one for the first time. I was skimming some blog (maybe Allnurses) last week that had female providers discussing how to retract the foreskins of male children and adults. Why would they think that this is just fine and dandy when so many young men are humiliated and mortified by these kinds of (usually unnecessary!) exams, and this leads to not only avoiding the make’emsick industry altogether (actually, most people will be healthier by avoiding the industry), but leaves many with lifelong emotional scars? Hmmm…. And until recently, these medical morons in the US, especially the females, didn’t know it could harm a male child or teenager to have his foreskin prematurely retracted – that is – ripped down! Stupid is as stupid does…

Perhaps I (and others I know) are the true outliers. I have absolutely zero trust in the make’emsick industry and its workers, wherever they are on the scale, from physicians to NAs/MAs. As I have 30-60 IQ points on the average physician (I come from a long line of physicists and philosopher/poets and the two arenas are not as different as they may seem as they both permit for highly critical thinking abilities), why would I trust someone who is hopelessly corrupted by a false medical model? I would only consult an MD (would never accept a PA or NP) in extremis, armed with a protector (advocate) and my attorney’s number on speed dial! And though I may need a diagnosis, for the most part there is nothing these physicians could offer me outside their regime of dangerous pharmaceuticals and many times equally as dangerous surgery. I won’t go into detail as this is a blog for male dignity, but suffice to say I have lifelong health issues due to individual providers’ malpractice as well as the industry’s widespread practices that are making so many of us, especially our children, damaged for life. And, many decades ago, I was abused on several occasions. I remember hitting one male doctor and he wheeled around and scurried out of the exam room like the dirty little rat he was! I was just a young thing at the time, and tried to forget it, but the awful feelings are still with me decades later. So, I have some personal experience in this area as well.

Now, the fact that medical “care” (can one scream and vomit at the same time?) is seen as the third leading cause of death in the US is old hat – some 2 decades years outdated. The true fact of the matter is the make’emsick industry is the LEADING CAUSE OF DEATH and everyone from Big Pharma, individual providers, and hospitals are fighting not to have the Codes updated so as to truly reflect actual causes of harm and death. (Look it up –the real stats are out there for those that wish to take the time to research.) Their facilities would be almost empty! I can tell ya, folks, people like me just don’t go! A yearly physical exam is out of the question! As regards nudging I call it bullying/propaganda, and if any medico tried to convince me that a certain drug, vaccine, or procedure is considered “standard of care” (The Exorcist vomit!) depending on the provider’s attitude I might very well consider this bullying and would respond appropriately. And here’s the point: Using useless and meaningless terms such as “evidence based medicine,” “standard of care,” “we’re all professionals,” “patient dignity is respected” etc. is nudging/bullying, more, it is lying.

I’ll briefly mention one more example of the lies of EBM, that of enhanced MRIs. Talk about a euphemism! The EU has restricted/banned many GBCAs as yes gadolinium is deposited in the brain, bodily organs, and bones, and has harmed untold numbers but now people are waking up to this particular scam and are suing: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Gadolinium-containing_contrast_agents/human_referral_prac_000056.jsp&

But of course the good ole’ FDA though it admits GBCA are deposited in the brain finds no evidence that heavy metals in the brain (and other areas of the human body) are damaging! Like radiation, heavy metals are incredibly damaging and yep I’ve got another friend permanently damaged by multiple “enhanced” MRIs. That PAs and NPs as well as PCPs are ordering these dangerous tests leads us back to the lies of EBM and of course, good old fashioned greed. Physicians admit to ordering over a million unneeded tests per annum for the kickbacks but we know this figure is much higher. This does not occur in other medical systems where kickbacks are not allowed.

So, we have a false medical model, an industry that does significantly more harm than good, and mostly female medical workers doing their best to peep on male clients, all topped off with a huge dose of greed! What’s not to trust?

Thanks for listening…
EO

BEGINNING JUNE 1 2018 THERE WILL BE NO FURTHER COMMENTS PUBLISHED ON VOLUME 87 BUT COMMENTS CAN BE CONTINUED ON VOLUME 88.

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04/10/2018

Patient Modesty: Volume 86



The above graphic for this Volume really shows distinctly a major discussion point which has continued on our blog thread, literally for years: the requirement for the patient undergoing surgery with general anesthesia to have his underwear removed, in this case for his arthroscopic knee surgery. The story is told by an onion farmer in his blog "Mucking It Up in Muckville"

I hope my visitors here go to the above link and first read the patient's story.  Then, come back and  continue, reading the experience and view of an anethesiologist-ethicist Dr. Alyssa Burgart.  I have been given her permission to reproduce her presentation here but besides writing your Comments to my blog thread, you should go re-read the text and write your comments directly on her own blog "Medicine, Ethics and More" and therefore to her own readers.  I am pleased to be able to get Dr. Burgart's experience and knowledge in both her areas of experience.
Her blog address: http://www.alyssaburgart.com/blog/2018/04/11/underwear-for-surgery/ and here is what she wrote:




Why was I asked to take off my underwear for surgery?









It can feel weird to be asked to take off your knickers… Underwear makes us feel proper, protected, clothed. Even though I get that those are concerns, there are several reasons why you may be asked to remove underwear:
Number One and Number Two
Under general anesthesia, patients sometimes pee and/or poop. It’s not pretty, it’s not always easy to know when this will happen, and we usually ask patients to use the restroom before surgery by means of prevention. If a surgery will be very short, the risk is lower. It is completely irrelevant which body part being operated on when the whole body is anesthetized and unfortunately, this can be a messy situation. The nice, clean skivvies the patient wore to the hospital are going to be peeled off and put in a biohazard bag. Patients do not necessarily bring extra underwear with them and don’t have any to wear home. Removing the garments before surgery means the patient can put those clean undies on when they wake up. We usually still have patients lie on an absorbent towel/pad, just in case. Undies or no, the nurses in the OR are going to make sure the skin is cleaned before the patient wakes up.
Time
If a surgery is long, a Foley catheter is typically placed to drain, collect, and measure urine. Placing the catheter requires sterile prep of the genital area and underwear are going to be in the way. They won’t fit properly and can apply unwanted pressure to the catheter once placed. This can even cause a pressure injury to the skin.
Spic and Span
Some people (not you, I’m sure) wear undies that are not very clean. It’s a gross over-generalization to apply that concern to everyone, but for practical reasons, it can be easier to just have everyone take them off.  If you’re having a belly surgery, your skin will usually need to be cleaned as low as your pubic bone. Knee surgery? To clean the whole knee, it has to be lifted up and the prep drips down the thigh. Those undies can get saturated with cleaning solution. They might get stained with the dye in the soap, which is rude on our part. They may not dry very quickly– and this can increase the risk of a fire during surgery (yeah – we have to worry about your pants on fire!). Realistically, the only procedures that underwear don’t get in the way are those on the chest and above.
While You Were Sleeping, We Got Back Pain
Is it more awkward to ask a patient to take off their panties or, if they absolutely have to come off, to take them off when they’re under anesthesia? Personally, I think it’s weird to wait until someone is anesthetized to take off their tighty whities. Then the patient wakes up having lost their underoos. If they need to come off for any number of reasons, I prefer the patient does it themselves. I think it’s weird to take them off in the operating room. Plus, it can take multiple people to get them off and we genuinely risk workplace injuries (back pain anyone?) to do so.
That’s nice, but maybe you still don’t want to ditch your briefs.
There may be hospital staff that get their panties in a bunch about your underpants. If you’re an adult, no one can MAKE YOU take off your clothes. If you refuse to do it, you can take your chances that your underwear will be on your body and be clean. But they may need to come off emergently (or because they interfere with the procedure you showed up to get) and that may mean they get cut off. There is dignity in controlling the removal of your own clothes, as I would personally find it more of an affront to emerge from anesthesia with clothing inexplicably missing. But that’s me. Maybe you don’t mind. There are perfectly uncomfortable mesh underwear that hospitals are likely to have on hand – meant to hold absorbent pads for post-partum or menstruating patients, or who have other reasons to need them. (To the above points, those will be promptly cut off if they are in the way, or of the patient urinates.)
When teens and adults are concerned about removing their underpants, I ask them why and offer to explain the reasons why it is called for in their particular case. Generally, I think the whole underwear things gets patients bend out of shape when they don’t feel they are being heard. Coming in for surgery is stressful, and maybe taking your tighty whities off based on the demands of a pre-op nurse is the last straw. When it comes down to it, patients are usually certain that they are just being asked to do something ridiculous, with not reasoning behind it. Secondly, they are concerned that their body will not be respected while they’re anesthetized and that it will be exposed for no good reason. By staff taking the question seriously, a dialog can form where the patient hears that they are respected, and staff have a chance to explain that this isn’t a thoughtless, nonsensical request to diminish inherent human dignity.
We have bet bter things to do all day than play power mind games with our patients. I can’t speak for every operating room out there, but I have yet to be in an OR where patients were left exposed for no good reason. First and foremost, we respect patients’ dignity and modesty. We have lots of sheets and blankets and use them to cover whatever we can. On a practical matter, it’s really important to keep patients warm, and leaving them uncovered is super counter productive.
On the surface, most of these reasons might seem like they are solely for the benefit of the healthcare people involved, but I think they are rooted in an effort to prevent patient inconvenience from dirty, damaged, wet, stained undies and loss of dignity from being given a biohazard bag full of soiled unmentionables, and to ensure that, above all, the patient gets safe care. If you disagree and refuse to take em off, staff should listen to your concerns to find an acceptable solution.
There will be no further Comments published on this Volume 86 as of May 6 2018. Continue the Comments on Volume 87,

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03/07/2018

Patient Modesty: Volume 85

I think this Volume's graphic really defines the basis for the ongoing modesty discussions which continues to focus on the behavior of some females in the healthcare profession with regard to their male patients but also importantly seemingly often the...

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02/05/2018

President Trump:Diagnosis and, if Necessary Therapy: Doing it Ethically









An excellent article written by physician-ethicist  Joseph J. Fins in Harvard Medical  School Bioethics Journal  and it is my reading that he suggests when it comes to the psychiatric fitness of Donald Trump to be the United States President, it should not be a psychiatric diagnosis (such as "sociopathy")  from afar but should be the education of the public in a clinical non-partisan fashion  by the psychiatrists of the symptoms of disease and it will be the public and their government to prescribe and carry out the appropriate treatment. 


In Dr. Fin's words:


In the context of the president’s personality, it is not an outright diagnosis that is needed per se but a public appreciation of what sociopathy is that can help inform a response. Medical diagnosis demands a high evidentiary standard. In the public sphere, mere knowledge of what sociopathy entails may enable the requisite scientific literacy for the citizenry to decide if observed behaviors fit a discernable pattern of psychiatric diagnosis that has a bearing on an ability to govern. This knowledge is especially important in sociopathy, which by its nature can obscure and seduce the observer. Human nature is drawn to sociopathy and vulnerable to its charm. Public awareness of sociopathy’s existence and nature is thus vital to deliberative democracy. This knowledge becomes a component of basic scientific literacy for deliberative democracy. Having said this, this knowledge need not require understanding at the level of clinical nosology. It may constitute essential knowledge like the germ theory of disease: even if they can not diagnostically distinguish an errant gastroenteritis caused by E. Coli or Salmonella, the public knows enough to engage in personal hygiene and perhaps avoid potato salads simmering in the sun at a summer picnic. Public knowledge about sociopathy has a similar utility: it can help guide behaviors and inform responses by our political leaders and journalists in the Fourth Estate as they do their work. 




So read the entire but brief article  and return with your idea of the role, if any, for the psychiatrists in relation to the American public with regard to President Trump.  Remember, this thread is not about presidential policies but about how to make a psychiatric diagnosis and who should be supervising any treatment.  ..Maurice.

GRAPHIC: From Google Images

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02/04/2018

Patient Modesty: Volume 84

Currently on a bioethics listserv to which I read and contribute there is a discussion about policies within the healthcare system which attempt to protect the participants of the medical institution from demands of patients with regard to race and eth...

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01/20/2018

Difficult Patient vs Difficult Doctor

One cannot ignore the potential for conflictive behavior as a potential in medical patient-physician relationships (and indeed associated with other individuals in the medical system interacting with patients and patients interacting with them.) This behavior can be disruptive to attain important professional relationships and effective diagnosis and treatment. 

The following is a brief analysis of the dynamics associated with such behavior and hopefully toward resolution as researched and written by a first year medical student.  The obvious goal, hopefully, is resolution of potential conflicts to promote a therapeutically effective doctor-patient relationship.  My visitors' views on this issue are welcome.  ...Maurice.

                   DIFFICULT PATIENT VS DIFFICULT DOCTOR
                                                           
                                           Surabhi Reddy
                                   First Year Medical Student

A doctor’s worst nightmare? A patient that is impatient, inattentive, rude, and demanding. A patient’s worst nightmare? A doctor that is impatient, inattentive, rude, and demanding. A so-called “difficult patient” or “difficult doctor” represent two sides of the same coin, with similar behavioral and communicative factors causing conflict. Occasionally, the difficult relationship may culminate in a
messy outburst – as recently seen in a violent altercation between a Gainesville doctor and patient.1  The duality of the patient-physician relationship allows us to examine (from both perspectives) what underlying actions and issues initiate the conflict – and eventually focus on mediation and resolution. Addressing the “difficult” nature of these parties is a vital first step towards creating positive patient-physician relationships and health outcomes.

You may hear the phrase “difficult patient” offhandedly thrown around in a physician’s lounge – a blanket term like “problem child” or “one of those” that draws universal understanding but little clarity on the specifics of the interaction. Physicians characterize 15-20% of all patients as “difficult.”2,3 Such encounters point to a strong association between the “difficult” characterization and patient mental disorder – namely, depression, panic disorder, and anxiety.2,3 Doctors note these patients are either 1) not interested in a medical opinion whatsoever, or 2) have repetitive, non-specific complaints.However, it was also noted that difficult patients are hard to describe and characterize as a group.4 Mental health does not preclude a difficult interaction. In a series of interviews, physicians described “difficult” as conversational issues such as patients being “violent, demanding, aggressive, rude and [seeking] secondary gain.”5 Physicians describe their primary motivations as the desire to solve medical problems and help others – and anything that stymies this process sadly draws the label “difficult.”

The onus is not completely on the patient, however. One study points out that the difficulty may stem from the doctor’s work style, belief system, and/or cultural barriers.5 The more experienced a family medicine physician is, the less likely he/she is to characterize a patient as “difficult” – suggesting that there is a burden on the doctor to develop the interpersonal skills to handle the interaction. Collectively, physicians that report high frustration with patients are those that are younger, work longer hours, and have symptoms of depression, anxiety, and stress.6 While physicians often characterize patients as difficult, patients are less likely to describe their physician as so. In most studies, patients are evaluated for their “satisfaction,” which includes many aspects of their medical care, including perceived expectations, the underlying medical condition, and other members of the healthcare team. This may also reflect the power dynamic between patient and physician. Patient complaints may be dismissed, once again, as the patient being “difficult” - leaving the physician immune to criticism.

The difficult patient-physician relationship involves both behavioral (mental disorders, stress) and communicative (rude and aggressive language) factors from both parties. Ultimately, cooperative relationships stem from respect, empathy, and patience. As one physician stated in his interview, “First of all, what I have learned with the years is being empathetic toward [patients].” Taking the time to understand another’s perspective can go a long way in making the difficult into easy.5



Sources

1.       Bever, Lindsey. (2017). A doctor shouted at a sick mother to 'get the hell out.' Now he's under criminal investigation. Washington Post.
2.       Hahn, S. R., Kroenke, K., Spitzer, R. L., Brody, D., Williams, J. B., Linzer, M., & Verloin deGruy, F. (1996). The difficult patient. Journal of general internal medicine, 11(1), 1-8.
3.       Jackson, J. L., & Kroenke, K. (1999). Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Archives of Internal Medicine, 159(10), 1069-1075.
4.       Koekkoek, B., van Meijel, B., & Hutschemaekers, G. (2006). " Difficult patients" in mental health care: a review. Psychiatric Services, 57(6), 795-802.
5.       Steinmetz, D., & Tabenkin, H. (2001). The ‘difficult patient' as perceived by family physicians. Family practice, 18(5), 495-500.

6.       Krebs, E. E., Garrett, J. M., & Konrad, T. R. (2006). The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data. BMC health services research, 6(1), 128. 


 GRAPHIC: From Google Images.

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