Why do so many doctors not listen to patients at all?

In My Humble Opinion
1

If there is one trend I have noticed over my life it is that many doctors might as well not even ask their patients questions, because it certainly has no bearing on anything anyway so everything would be more efficient without it.

How many times have I heard people describe telling doctors their entire complicated history of trying meds X, Y, and Z and only ever receiving relief from Z and even had a bad reaction to Y. At the end of the visit they walk out with a RX for Y :smack: This is ultra bad somewhere like the US where healthcare is expensive and everything is RX, not everyone has the money to go see a bunch of doctors til they get correct treatment.

My mother got on a new insurance and got a new GP, she went from one prescribed drug daily to more than ten! Her cholesterol and pressure were fine, but she was scripted meds anyway “in case” which she could not afford and she was foolishly purchasing fractions of the script and alternating taking them. :smack: She said this was making her feel weird and giving her high blood pressure not surprisingly, I pushed her to explain to her doctor she couldn’t afford them and the uneeded stuff needed to go and maybe switch to cheaper comparable meds. She finally told him and he freaked out on her, telling her he doesn’t know what her money situation is and he provides the best care possible without regard to money and if she can’t afford it it is not his concern and made her feel like shit, so she is back on her nutso med rollercoaster.:smack:

Constantly bringing up some strange typo in records, no I was not hospitalized with seizures at 15 I was only hospitalized with a broken arm at 5! etc.

Or not listening when a patient relates that due to cost or time etc they cannot follow treatment and need an alternative, only to be ignored. Which just leads to patient non-compliance and ignoring of the doctors impractical instructions. An example would be saying well if it is that bad just pop into the ER, which 99% of patients can’t afford to or cannot practically do.

Telling a patient who put off the visit because of monetary concerns to try an OTC med, when they clearly already said they used it and it didn’t work and they cannot function any longer. There is nothing more depressing as a patient realizing you could have saved a few hundred bucks for all the help you got.

2

All domain experts, from checkout cashiers to brian surgeons, do this. It’s because most people DON’T know what they’re talking about, so the doctor gets out of the habit of listening to the patient and assuming they know better. It’s especially awful for doctors. It’s possible to avoid, but only by taking a lot of time to fairly evaluate what everyone says, even though it turns out for lots of people just repeating your initial advice would have been better and a lot less work. Ideally doctors would be taught to watch for this and avoid it, but because they’re human, and because people get jaded looking at human problems all day long, and because they’re busy (because they have too much to do, or because they’re out of the habit of trying), only some manage to do so :frowning:

3

You need to know about this website: www.needymeds.org

It compiles, for free, a whole slew of drug assistance/price reduction programs, some from the drug manufacturers themselves, some from third parties. You can search by medical condition or by drug name and it will bring up a list of programs for which your mom may be eligable. Don’t just look up her expensive meds - look up the cheaper ones, too. Sometimes a patient can’t find a program for her most expensive med, but can end up trimming $5-10 a month off 4 or 5 other cheaper meds she’s on, and that helps her afford the expensive one!

Okay, that out of the way…I hear ya. Boy, do I hear ya. Not a week goes by where I don’t have to call a doctor because they’ve made a mistake. As soon as the offices open in a few hours, I’ve got to call a doctor and let him know he prescribed a medication the patient is allergic to, and the allergy is listed on the office visit note his nurse faxed me, so it’s not like they don’t know about it! Trust me, those are never comfortable phone calls - no one likes to be corrected.

On the other hand, I’ve also seen a lot of patients who are afraid to actually speak to their doctors honestly and openly, and that makes it hard for a doctor to “listen” and prescribe appropriately. Some people are intimidated by the white coat. Some are embarrassed by their medical or financial situation and try to hide it. Some don’t understand the questions and are afraid to look ignorant by asking for clarification. Some don’t remember or never knew stuff - not just complicated details, but really big things in their medical history (I started a thread recently on the phenomenon I’ve noted of elderly women not knowing if they have had a hysterectomy or not!)

I can’t tell you how many times as a nurse I’ve had a conversation like this: “Have you ever had a major illness?” “No.” “Any surgeries?” “No.” “Have you ever been in the hospital?” “No.” Then I do a physical exam, and there’s a huge scar on their belly! “What’s this?” “Oh, I had my appendix out when I was 26.” Really? And you don’t consider that a major illness, a surgery, and you weren’t in the hospital for that?! Arrrrrgh! Getting a good patient history is really, really hard sometimes.

Some doctors just don’t know what meds cost, often on purpose - they don’t want economics to cloud their medical judgement, which I can respect, actually. If you were poor, would you want to be told about only the oldest, most side-effect laden cheapest medication? I’d want to know about all my options, and investigate ways to afford the one that would actually be best for me, even if it’s not the cheapest at retail.

4

Missed the edit:

OTOH, once a patient brings up finances as a concern, that should absolutely be listened to and worked with. Every Patient Bill of Rights in hospitals and medical offices that I’ve ever read (yes, I’m the person who reads stuff like that) has included finances as a valid piece of the medical decision making process.

5

Last year I got an allergologist visit for my supposed allergies. Diagnosis: “not allergies, this is not my line at all!” “OK, so what should I do?” “I don’t know [gesture: nor do I give a shit]”
A few months back, I saw a GP who hadn’t seen me before, and the subject of my non-allergies came up. She said it sounds like they’re “sensibilities” rather than “allergies” and gave me a script for a new med. I bought it, got home, read the brochure: it’s specifically contraindicated for sensibilities.

Thankfully there are a lot of doctors out there who both listen to patients and read the fucking pharmacopedia, but sweet Jesus, is it that much to ask? Some of the ones I know who do both, do both after I gave them a lesson in patented Sesame Street Style… where do I sign up for my overdue medical-school-professor salary?

6

I recently had the pleasure of visiting a doctor because I was worried that an ongoing cough might be walking pneumonia or something else I just don’t have time for–and after being asked lots of factual questions, she asked “do* you* think you’re sick?”

My answer was no, and it was a relief to be asked. What a nice experience.

7

It drives me crazy, too. Thankfully I have doctors now that actually sort of listen, but I only go to them for run-of-the-mill things - allergies and such. I am frightened thinking of having to go to any of them for any actual problems.

8

Not that I’m any sort of paragon of assertiveness, but I’ve found abandoning the meek “yes, doctor” attitude is enormously helpful in getting them to listen to you. Maybe I’m just of a certain age, but doctors seem to be getting younger and younger, and I’m just not going to let some dumb kid tell me he knows my health situation better than I do. :stuck_out_tongue: I ask questions, lots of them, and don’t let them run off without answering.

That said, I may just be fortunate in my providers; they do seem to sincerely believe in patients’ rights to participate in their care. For example, after a coworker/friend told me how sick she was of being ignored by her obstetrician, I recommended my doctor and her group, and she is completely thrilled by the change of attitude she’s found there.

9

I would guess that about 50% of the time I visit a doctor, he/she doesn’t actually understand what I am there for and too often don’t really care. They do their doctor routine of poking and prodding and just ignore the sounds the patient is making. They should have become veterinarians.

When I visit a lawyer billing $300-400 an hour I expect them to listen to every word I say and to be very precise and accurate in their answers. While some doctors, billing something like $200 for 10 minutes of their precious time, can’t be bothered to even listen to the words I am saying, much less be bothered to read a chart or come into the room prepared.

The answer for why they do it is easy, because they can. If you are sick and need help the medical industry has you by the short hairs and doctors are the high priests. Your choices are be sick or go to the doctor, open your wallet and hope for the best. Sometimes, no - often, you do get the best. But sometimes you get a useless ass with a medical license who is just putting in his time and going through the motions and you can waste a lot of time, money and health trying to sort things out. And there is no mechanism that I know of to do anything about that useless doctor.

I visited a new GP last year because I felt I had breathing problems. I was looking for a new GP anyway and had something that needed checking. I met an assistant of some kind who had me breath into a tube once then left. Then the doctor came in, never looked at me or even in my direction, wrote me some prescriptions and left. He had decided I have asthma so he gave me three of the items one sees on TV for asthma. No instructions, no advice. I tried them, don’t see any difference. Now my insurance has decided I have untreated asthma and are nagging me to go back to that doctor and get back on those medications. I have found another GP who is actually useful but the asthma thing is following me around now because of my insurance’s wellness program. Who knows, maybe I do have asthma but it sure wasn’t found by doctor lazybones.

10

I wrote all the above out, forgetting this terrible experience I had a few years ago with a doctor I mostly think is on the ball and very considerate of his patients’ opinion. I have had allergies all my life, and for some inexplicable reason, the symptoms changed in my 40s from sneezing to unbearably itchy and sensitive skin. This skin problem is year-round (so I take Zyrtec daily) but during the spring, when my allergies are at their absolute worst, they don’t cover the whole problem. I went to the doctor, was prescribed something, and it didn’t work.

I called back a few days later and requested that, as the doctor and I discussed, I be issued a new Rx for something else. The nurse who took the call said she’d pass on the message. Or so I thought.

Days went by, and through some misunderstanding, on hers or my part, I didn’t get it that such things only took place on Wednesdays. What, I don’t know. It had to do with insurance. I only knew that by Friday, I was in agony, and called to again plea that I have my medication changed, and was told very coldly that she’d attend to it on Wednesday.

WHAT??!!! No, honey I am in agony now and I cannot wait until Wednesday. Oh, I let her have it over the phone. Well then 10 minutes later the doctor calls me back and fusses at me for YELLING at his nurse and dragging him out of the exam room with another patient.

Let me tell you I was in tears. I was in so much agony (my skin felt like it was on fire, AND it itched, intensely) and here was my trusted physician yelling at me for dragging him away from a patient. I cried, said I was sorry and when he calmed down, he apologized, profusely, and told me that they weren’t “hearing” me that I needed help. I guess they thought I was just some dumb bitch who thought her measly little problems were more important than the smooth running of the office.

They are still my doctors but I am really, really loathe to go back, despite the fact that they’re internists and my primary care physicians. Even though I was apologized to, I feel like I was treated like some crazy person for no reason.

Grr.

11

Economics is a huge factor. More patients per hour=more money for the doctor. Listening takes time, and time is money.

12

“Why do so many doctors not listen to patients at all?”

Because many of them are arrogant asses with God complexes.
I have had many health problems in my life, and I have suffered through many misdiagnoses.
Has any doctor ever admitted to making a mistake with my health ? Never.

13

You seem to have specific instances in mind. I wonder if you could tell us what the impracticable, non-compliable treatment modality was and what you had hoped would be offered as an alternative. Likewise, what OTC medication was suggested versus what prescription medication you sought.

14

Because I am a psychologist who specializes in the care of clients with chronic health problems, I hear doctor complaints all the time. As a profession, it has huge problems, but like I said above, I think most of it is that economics plays too large a part. If doctors were paid a flat fee, or by the hour, they would take more time with patients.

I don’t think this is because most doctors went into the field to be money-grubbing bastards, but they get caught in the trap of thinking that they are not successful if they make less than $200,000 (or whatever their specialty pays, on average). Not successful doesn’t sit well with high achievers, so they start to spend less time with each patient, etc.

15

Why do so many doctors jump to conclusions without considering all the possibilities?

Several months ago, I went to mine and asked what to do about my chronic insomnia. Immediately, the answer was “It must be anxiety or depression. Here, take this melatonin sample.”

The sample did nothing. Later, I read a Dr. Oz article about the need to keep the bedroom cold–the colder the better, if the insomnia is severe. I tried this and it has worked very well ever since.

Anxiety or depression, black or white, A or B, binary thinking.

Please.

16

I wish I knew.
Sometimes I think it’s because doctors see so many patients, and hear very similar problems so consistently, it’s just *easy *to jump to the quickest conclusion. Most every profession has habits they get into, and those habits make life easier for them. Gotta cough? Take these antibiotics. Back pain? Do these exercises. It’s just a call and response the same as you telling your boss the TPS report is “almost done”.

17

Two words, from Gregory House. “People Lie”.

18

I once had a doctor who was really great in that respect. He took a lot of time with each of his patients, and listened to them carefully. I knew he remembered what I said, too, because he asked me relevant questions on my next visit.

The bad part was that he was always running very, very late because his appointments always took much longer than scheduled. Typically if I had an appointment at 3:00 pm I would actually see him at about 4:30.

19

I’m not going to come in here and defend those of my profession who don’t listen at all, but do feel that this thread could do with some perspective of why it sometimes feels that way even when good doctors are doing their best -

All of us in all areas of expertise use heuristics, cognitive short cuts; no one, in any field, ever really considers all the possibilities. We instead go with general pattern recognition. We deal in managed uncertainty. If we are good we don’t “anchor” on a conclusion prematurely, and instead remain sensitive to pattern mismatches as we hear the rest of the story and gather additional information. We confirm our short cut best guess with the rest of the story, the exam, and when needed, testing. But let’s face it, none of us will never make that mistake. Sure some make it more than others. Some are arrogant. And for many in adult general practice there is a huge pressure to see enough volume that they can pay the bills and service their med school debt. To patients those occurrences, those mistakes, are what stands out rather than the 99% plus that the short cut was correct.

Yes, some doctors are just not good at listening or just are very impatient, especially after every detail has been told Edith Bunker cling peaches style. Some do not realize that trying to rush the process often means it takes longer. Some don’t realize that certain habits leave patients with the perception of being rushed even though the doctor in reality spent a long time in the room, and that other habits can leave patients feeling they’ve all the time in the world even though that doctor was in and out much faster. Things like leaning back in the chair and making eye contact, letting a patient completely finish their thought and playing it back to them in their own words (so-called “active listening”), being sure to finish with “Do you have any other questions and is there anything else you on your mind while you are here?” … many are particularly afraid of what cans of worms that last bit will open but personally I’ve found the response to most often be a three second pause as they think, and then “No. That’s it. Thank you.” And leaving with a much greater perception of having all the time they needed than if I had not asked the question. Occasionally I’ll get a big issue raised then, but often those were important ones. Sometimes another brief question. Rarely anything that takes much additional time.

Finally there is the most practical part of it. Scheduling appropriately in a successful practice is very difficult. We try to have protocols to allow the right amount of time for the listed problem but sometimes what the patient (or parent in my case much of the time) wants to talk about is a big issue when they only told the scheduler about a very straight forward one. People come late, or early, or more often than not all at once as if they carpooled. We don’t want to make other people wait so sometimes we try to rush through what seems like the most straightforward to catch up … with consequences of course.

Again, no apologies for those of my profession who don’t even try to listen, and I know they exist. But hopefully some perspective of the other side of the interaction.

20

Dseid"And for many in adult general practice there is a huge pressure to see enough volume that they can pay the bills and service their med school debt."

And buy that fancy car and fancy house. C’mon, dude, you know you can’t deny it.