Does Your Doctor Think That You're A "Difficult Patient"?

John Fisher
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Stopping Medical Injustice

Did you know that your physician is required to complete a certain number of educational lecture credit hours per year to keep his license active? The exact number of credit hours required varies by specialty. However, your physician has a number of ways in which he can complete them: he or she can (1) attend conferences where live speakers lecture on specific topics and procedures over a course of a few days, (2) purchase a DVD lecture series, watch it, and then take a short quiz to prove that it was viewed, (3) attend various live lectures sponsored by organizations such as the New York Medical Society or, (4) view lectures online sponsored by a physician-to-physician learning collaborative where physicians are encouraged to share and learn from one another's experiences.

One physician-to-physician learning collaborative, QuantiaMD, is causing outrage among patient advocates after airing its newest lecture series: " Managing the Difficult Patient: The Five Faces of the Difficult Patient". The series consists of five segments: "The Angry Patient", "The Legal Risk Patient", "The Patient Who Knows Too Much", "The Chronic Pain Patient" and "The Patient For Whom Nothing Works". In particular, "The Patient Who Knows Too Much" has garnered the most anger from patients and patient advocates. While thousands of doctors have flocked to the site to view the lecture with positive reviews on the series, patient advocates think that it drips with condescension and criticism towards patients that have sought to educate themselves about their health.

The lecture opens with a picture of a cartoon patient holding a computer. With large black glasses, a bad haircut, and a collared-shirt buttoned all the way up to his chin, he is without a doubt meant to be portrayed as the stereotypical "nerd". The moderator of the lecture series, Dr. Richard G. Roberts, President of the World Organization for Family Doctors voices over the picture to inform the viewer that the patient's name is "Will" and is a "computer engineer" who "downloads the most current information" from the internet before visiting his doctor. "Will" then bombards his doctor with questions about "one disease or another" during his visit.

Next, three lecturers, Dr. Joseph Scherger, Vice President for Primary Care at Eisenhower Medical Center in Rancho Mirage, California, Dr. Leonard Haas, Clinical Psychologist and Health Behavior Coordinator at VA Healthcare Center in Salt Lake City, Utah, and Dr. Gerald B. Hickson, Director of the Center for Patient Professional Advocacy at Vanderbilt University School of Medicine address the challenges that Will poses to his treating physician and how one should best handle him.

According to Dr. Scherger, patients who know too much often "consider themselves an expert yet often their true medical knowledge is quite limited". Scherger suggests that treating physicians should promote a healthy lifestyle to this type of patient as they are typically "very overweight...out of shape...[and] on the Internet all the time". Dr. Haas states that "patients who present their expertise as telling you how to practice medicine are implicitly discounting your expertise". All three lecturers harp on the fact that internet-educated patients take up a large amount of time during their visit which can prove frustrating for busy doctors.

Patient advocates argue that while patients that research possible conditions may be frustrating or annoying, researching their health could save their lives. For example, Jill Raleigh, executive director of the LAM Foundation, a group for patients with the rare lung disease, Lymphangioleiomyomatosis, argues that most LAM patients' physicians know very little, if anything, about the condition and that the patient is usually the one who must educate his or her doctor on the latest treatments and developments for the disease.

Mary Modahl, chief communications officer with QuantiaMD, says that QuantiaMD now realizes "The Patient Who Knows Too Much" is a "poor title" for the lecture and that "certainly a patient can never know too much." She argues that the purpose of the lecture was to teach doctors to deal with patients suffering from panic disorder who visit their doctors frequently with a variety of different complaints and have sought the advice of numerous specialists.

After reading a number of different articles on this lecture series, I decided that I just had to see it for myself. So I logged into the site (it's free) and watched it. It appears that QuantiaMD has taken some of the criticism to heart, as ‘The Patient Who Knows Too Much" has now been renamed "The Cyberchondriac". However, I don't believe that the change in title was enough. The lecture is exactly the same and the most offensive portions still remain (such as when Dr. Scherger states that most internet educated patients are overweight). Although watching the lecture as a whole versus reading small snippets of the dialogue in articles did make the lecture seem less offensive, on the whole it does take an alarmingly condescending tone towards patients that are most likely very concerned about their health and are just trying to receive the best treatment available.

I also watched a number of other segments in the series including "The Patient For Whom Nothing Works". This patient is represented by a cartoon picture of an elderly woman and is characterized as a patient for whom treatment doesn't work and is "likely not following the advice of her physician". This segment actually bothered me even more than "The Cyberchondriac" because the lecturer seemed to just assume that any type of treatment failure is the fault of the patient when nothing seems to work on his or her condition.

I think that doctors who condemn patients "for whom nothing works" or who are "over-educated" are climbing a slippery slope in dismissing the validity of their complaints. I think that doctors that assume that these types of patients are simply either hypochondriacs or are not following treatment orders run the risk of missing life threatening or rare disorders. While its true that these types of patients may be frustrating for physicians, let's face it, the bottom line is that physicians are paid to treat and deal with patients...no matter how frustrating they may be. I acknowledge the fact that QuantiaMD may have been trying to educate doctors on how to deal with patients that may be frustrating to them; however, I really don't think they did it with the amount of tact and skill required. What do you think? Should QuantiaMD change their lecture series or was a title change all that was required to make the series less offensive? Check out the series by logging into QuantiaMD here: http://www.quantiamd.com/!

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