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

In My Humble Opinion
21

One of the best docs I know had a Honda Civic over a decade old and a modest house. When his car was stolen and totaled, he bought the exact same model year as a replacement. :smiley: He worked for a state university hospital, got paid a crappy salary, and only left (for another non-profit hospital) because he wasn’t treated like a valued staff member.

Let’s not forget the docs that have gigantic malpractice insurance bills to pay merely because of the field they’re in; some OBs and neurosurgeons apparently pay over $100K a year for their insurance coverage, last I looked into it.

22

With median salaries of physicians running around $200,000 (and that’s take home, post expenses like malpractice) not all of that money is going to paying the bills and medical school debt.

Kudos to the MD you knew, Ferret Herder, but I am tired of doctors pretending to spend all their money on medical school debt while driving expensive cars and buying 3,000+ square foot homes. The fake poor-mouthing I have read lately from MDs just makes me ill.

Do you know why most psychiatrists (and I mean at least 90%) don’t do therapy anymore? It doesn’t pay enough per hour. They can make more doing 10 minute long medicine checks, so that is what they do. A psychologist who makes 60,000 to 80,000 a year is happy to making that much; a psychiatrist is a failure if they make less than 120,000.

23

I am not complaining but my 8 year old Civic does belie your fancy car belief. I am years out though and did not graduate with immense debt. I am doing fine and know it. I love what I do and am thrilled to be paid well for doing it. But I am really talking about quite a few others on the primary care side, especially in that first decade out. Perhaps this article can help explain how the current debt load impacts. The major impact is that fewer go into primary care and choose the better paid specialties instead.

This article also may be of interest.

24

DSeid, I get where you’re coming from. I’ve seen all kinds of doctors myself, working in the medical field.

I can only think of one particular bad doctor I’ve personally had (ER doc, misdiagnosed a broken toe as sprained because he held the X-ray up to an overhead fluorescent light rather than a viewer), and apparently my pediatrician when I was little was pretty egotistical. Oh, and I once worked for one that you wouldn’t want working on you, but he was really nice and pleasant and spent time with his patients so he was fairly popular. :eek: In his specialty, you wouldn’t necessarily know that he may or may not be making the best decisions in your care… I preferred one doctor I worked for who I mentioned above, but he was so overbooked and never ran anything remotely resembling within an hour or two (at least) of “on time” due to how much explaining and talking and listening he’d do… and there really weren’t any fixes for that unless he got abrupt and cycled people through like clockwork, or started firing patients by the dozens until he got a smaller population to handle. But so many people wanted to see him.

Dealing with patients every day and being one myself at times, I know that a lot of people would do better (even me!) if they followed those “tips to get more out of your doctor’s visit” articles that pop up in magazines, online, etc. Stuff like a medication list with doses, when you started taking it; a list of your general medical history (diagnoses, dates, surgeries); a list of questions and medical complaints, that kind of thing. Don’t ramble, don’t talk about your friend who had X and would that pill work for your case, etc. I know it won’t work for every problem, but it makes your visit so much easier for the staff and for you too. I swear, I almost cry with joy when people pull out a list of meds, because it happens so infrequently. If you have relatives that you know will not stand up for themselves in such a way, who won’t speak up if an error happens, then try to find a way to assist them.

And for the love of all that’s good, if you think your doctor sucks, please find another one if it’s at all possible. Report crappy doctors to the medical staff office/Chief Medical Officer/whatever of the medical center they work for, if they are associated with one or with a hospital. Write a concise, fact-based letter outlining your issues, what you did to try to correct/rectify the situation, and recommend things like bedside manner instruction or something like that. Hospitals don’t like bad publicity, and they will usually appreciate a heads-up about doctors who suck for whatever reason.

And regarding the “House” quote above - yeah, some patients do lie. That really presents issues. Hopefully I’m anonymizing this enough… We had a case where a patient needed surgery, and was extremely eager to get it done ASAP. He had a medical clearance. Outpatient surgery was performed, and he was told that another doctor would be handling his post-op checkup the next day, squeezing it in amongst her other duties.

The patient was in pain the next day. This is to be expected. He was also a jerk.

Turns out he’d intentionally concealed an important bit of info before this so as to not delay surgery (else he’d have needed another procedure first, and he didn’t want to wait) and now this had caused complications. He yelled at the doctor about how she wasn’t listening to him (she had been, she just wasn’t agreeing with him), how she had to shut up and pay attention, he was going to report her to her boss, she was just running around dealing with other patients and ignoring him (sorry, she did have other patients, but part of his time was with her and a good amount was in testing), and a bunch of other stuff that drove her to the point where she merely excused herself and sent in one of the chief residents to reason and make nice with the guy. I have never seen her so livid.

The man’s adult son called later on, absolutely indignant over how we had supposedly treated his father. Due to HIPAA, there’s only so much you can say except that the situation was not as presented and that you are concerned that he is making poor health care decisions.

25

I found out that I had a cousin of some degree or another [everybody in western NY with my surname is related even if we don’t know each other.] who had the same first name, no middle name though she was something like 50 years older than I. I found out because I was checking into the hospital for surgery and at the time I was single, never pregnant, only issue I had was dealt with in a pediatric hospital and totally unrelated to anything gynecological. The assistant doc to my practice came storming in muttering about lying about never been hospitalized for <something medical I didn’t recognize at 15> which totally baffled me. Then he said something about being admitted for a pregnancy in 1972 and I pointed out that in 1972 I was 11 and not pregnant in any way. Then he looked at the birthdate on the record and agreed that there had been some sort of mix up. Later, I asked my dad and he did agree that he had a cousin that married into the family with my name a couple years after I was born. :smack:

I am very glad now that hospitals confirm and reconfirm identifications now …

26

I wish billing departments were required to check as many identifiers as I am in my job working with patients. My husband and his father (same name) have been seen at the same hospital and in the same clinic network. You can imagine the mixups. :smack:

Once my PCP walked into the exam room, looked at my chart, and said quizzically, “You’re here for… clearance for a hysterectomy?” She looked at the tab on the chart where the name is. Her face grew taut and she excused herself from the room. A few minutes later, she returned with my chart and my correct reason for being there. My name’s pretty unique so I’m assuming one of the clerks put the wrong visit sheet in the wrong chart, or something like that.

27

That’s okay…we got it covered. (Or will, someday.)

And, bonus, patients like it better for just what we’re seeing in this thread:

28

Yes, of the docs I do know who have fancy cars and sweet houses, they are typically those who have been in practice for a good long time.
I suspect many people really do not appreciate how significantly student loan debt has ballooned over the last few years, especially for medical school.
I graduated med school a few years ago with $250,000 in debt (and that’s not considering that residents generally are not able to do much more than pay on the interest that continues to accumulate on their debt during residency rather than making a dent in the principal). I know other docs my age who have more debt than I do. None of us are living large.
Another issue is that if you’re talking about a doc who is working for a group, depending on the specifics of the contract, there’s a good chance he’s expected to see a certain number of patients in a certain amount of time by the bean counters. If the doc is working for himself, he may need to keep a steady pace to be able to afford the overhead associated with running his own practice.

I also think that many people don’t appreciate how much a lot of people who go into medicine have sacrificed over the years to get to where they are.
Most of us who are in medicine have made a number of personal sacrifices over the years for our career. I spent years missing family events because I had to put med school first, relocated to another state based on the whims of the residency match, spent many nights sleep deprived on call. There is an expectation from society and your colleagues that medicine is more than just a job - it’s your life. Many people go to med school not fully appreciating the sacrifice they’re signing up for until they’re in the thick of it.
I knowingly chose a specialty on the lower end of compensation for physicians, but after what I’ve put in, I think I’ve earned whatever I do get out of this job. If you resent me for that, and you think I have it so easy, why don’t you go to med school and show me how I should be doing it?

29

I guess I’m just very fortunate, or more assertive than usual, because I rarely, if ever, have encountered this. My primary care doctor is exquisitely good at listening. It is probably just coincidence that this is a woman doctor.

I have seen a couple of specialists recently as well, and I expect to be listened to and to have answers to my questions and concerns. One specialist kept trying to suggest a medication I was not comfortable with, so I got a second opinion and the condition was addressed much better with that doctor.

30

I’d go beyond that. If you have a problem in an office with a doc or with the process, let the doc or the office manager know, not just when you think the doc is crappy. We cannot get better if we don’t know there is something wrong. Don’t worry about insulting a doc you like or bruising an ego: as a general rule doctor’s egos are pretty secure.

Without doubt NPs and PAs are providing more and more care and expanding their roles. Many are better communicators than are many docs and most are much better at following guidelines. That said I read that study and find some things of concern. More “investigations”, as apparently were ordered by the NPs, is not better and is often worse care even if patients are more satisfied because an X-Ray or a CT or a lab panel was ordered. The huge drive to expand with NPs and PAs is most one of perceived cost savings (and is promoted heavily by the bean counters) but the article states it well:

That said a young man or woman interested in providing primary care today really has to think if the debt load and delay of income of medical school is worth it, or if they’d be better off putting that money in a mutual fund and going the NP or PA route.

Also as an aside … medical education has recognized that they have heavily selected for science and math skills and that such may be overweighted in importance. The soon to be new version of the MCAT is much more humanities and psychology weighted in response to that and the sort of classes pre-meds will take may change as a result. They know they need to teach listening more and that a focus mainly on creating medical scientists is not the best thing for health care overall. I’m not so sure they quite know how to do it though. It will be a work in progress.

31

Here’s a comment / question on the subject of this thread.

I am on Medicare, having a Medicare Advantage plan with a large private HMO that hires its own doctors and staff and runs its own facilities. I’ve only had routine and outpatient care, which I have always thought is seriously perfunctory. Here’s something I’ve noticed: The VAST majority of doctors have nearly-unpronounceable Indian or Asian or South-East Asian or Eastern European names, and got their medical training in those places.

As best I can tell, and from what other people say, they are good doctors, or maybe as good as the HMO lets them be. Here in America we’ve got this stereotyped popular notion that American education at all levels is going down the tubes, and we’ve all heard those fabulous stories about the wonderful medical business happening in India, Indonesia, Malaysia, Nepal, etc.

Question: Is it true? Are foreign medical schools, teaching hospitals, etc. (especially Indian, Asian and South-East Asian) really getting really good, as one popular line of thinking seems to hold? Here in America, are those imported doctors really the best, better than American-made docs? From my limited exposure, I’m inclined to agree with that. There sure seem to be a lot of them, at my HMO at least.

What do y’all think of that?

32

For all the science doctors seem to know, why are they so bad at listening to evidence based medicine rather than forming their own opinions based on life experience? At least, I’ve never met a doctor who didn’t think he knew more than the contradicting studies on a subject, save for one who is actually also a good listener.

33

Since other countries such as the UK have made it much harder for doctors from outside the country to work in their system over the last few years, most third world country doctors who want to immigrate to a first world country try to get into the American medical system.
There are a huge number of doctors from places like India who are competing against each other to gain access to the American residency system. There are a comparatively small number of residency spots available to them (especially because many programs tend to favor American graduates over foreign grads), and therefore the ones who do make it into America tend to be the top performers from their country.
Among the docs from India that I’ve known, they often had impressive credentials in research or had already completed residency training elsewhere before they came to America and started over as a resident, above and beyond the credentials an American graduate would need to get into the same program. I have seen situations where cultural issues or a language barrier has caused problems with patient communication when the doc is from a foreign country, which could lead to complaints like what we’ve seen in this thread, but I would say that most of them are very intelligent and knowledgeable.

34

Probably not, really. When a doctor is salaried, TPTB who sign his or her paycheck have very specific expectations about how many patients that doctor will see and how much billing will be produced, and those expectations are usually pretty high–usually giving you something like 15 minutes per patient to look over the chart, see the patient, and write up the visit. If you fall below these levels, you will be spoken to about getting your ass in gear and informed that if things don’t improve your contract won’t be renewed. TPTB have to make sure they’re getting their money’s worth out of you, after all.

Yeah, and that tends to piss off as many patients as herding them through like cattle does. And if he’d scheduled things more in line with how long appointments would actually take, people would have to wait forever to get scheduled, and that would also piss them off.

What people want is for a doctor to be able to get them an appointment quickly, run meticulously on time for that appointment, and spend however much time they want in the room. And that’s like wanting food that’s fast, cheap, and healthy; you can have any two of those things, but you’ll wind up having to compromise on the third. You can have easy rapid scheduling and run on time, but you’ll have to run them through on a conveyor belt. You can take lots of time on appointments and run on time, but you’re going to booked way in advance and people will have to wait ages to get an appointment. Or you can schedule heavy so people can get in easily and take plenty of time on each patient, but you’re not going to be anything like on schedule.

I would never have come up with that description myself, but it’s perfect. That is exactly what it’s like talking to some of these folks.

35

But you are still letting economics (of which a big part is doctor’s salaries) run the show. I run a psychology practice where I see each client for 50 minutes, don’t overbook, and see everyone precisely on time. I listen to my clients and give them excellent care. If a client loses their insurance, I continue to see them for their co-pay, or if they can’t afford that, for free. How do I achieve this miracle? I make less money than physicians would ever dream of. I don’t think “I’ve earned whatever I can get out of this job.” I think I have the best job in the world. I drive a Vw Beetle, and live in a $130,000 home. I spent 7 years in graduate school, making only enough for crappy apartments, and then a year of internship and post- doc making only slightly more, so arguments about medical school don’t sway me too much. I’ve put in my time.

I have worked in hospitals alongside physicians, and by and large, they are an entitled bunch. We all had to sign notes, for example-- nurses, doctors, and psychologists. Only the doctors got someone hired to review the charts and find the missing signatures. Only the doctors had to be threatened with withheld pay to go sign them.

Again, I think this is all about expectations. Our society and the culture of the health care system have built up this expectation that doctors must be highly paid. In order to achieve that, they have to run patients through on a conveyer, and end up feeling bad about the way they practice, so they justify their behavior by blaming patients, and end up hating their work. It’s sad, really.

36

The other day, I was in a patient’s room when the cardiologist walked in, took a seat next to the bed, and asked the patient, “So what seems to be the trouble here?”

The patient took a deep breath and started, “Well, when I was a little girl…”

I finished what I was doing and cleared out, laughing under my breath. Poor man.

37

This reminds me of the first time I took my late mother-in-law to my excellent primary care doctor instead of the quack she had been seeing. After about 20 minutes of listening to the old lady rambling on about all kinds of tangential matters, the doctor suggested we schedule another appointment for a longer time slot.

38

That’s not a function of doctor salary, though; it’s a function of our allowing health care to be a for-profit business. Do you really, truly, honestly, in your heart of hearts, think that lowering doctor salaries would significantly lower productivity expectations? Because I don’t. I think the people running the place would go “Woohoo! More profit for us!” and leave everything else pretty much the same, just like when oil prices drop but gas prices stay steady.

Compared to other overhead–equipment costs, building maintenance, disposables, biohazard disposal and shredding services, ancillary medical staff, office staff, various types of insurance, paying for CME, benefits, etc.–doctor salary simply isn’t that big a slice of the pie.

As for your practice standards, I don’t really think it’s kosher to compare a situation where it’s expected that you’ll see 1 patient per hour and it’s okay to say “I’m sorry, our time is up; we’ll talk about that next week” to a situation where it’s expected you’ll see 4-5 patients an hour and you have to do everything you possibly can to address any additional problems the patient pops out with at the last minute right there and then in that visit. After all, I imagine most doctors could manage their appointment flow a hell of a lot easier if they could just tell someone “Sorry, out of time,” when the patient waits till the end of the visit to mention they’ve been nearly blind in one eye for the past week or so, and does the doctor think that might be a problem?

39

Just out of curiosity, Brynda, how much debt did you acquire getting your PhD in Psych?

40

I do wonder how it would go over if a primary care doc looked at his watch and said “Time’s up. Come back next week and we’ll continue hearing the rest of your story and discuss how to manage your acute and long term medical problems then, if we get to them within the allocated time.”

It is also of note that “the average debt for a psychology doctoral grad is $53,111”, not the $200K albatross that average MDs start off with. So yes, like Nocturne, I am also curious.

But I get it. Brynda resents that others make more than she does. She believes the stereotype of the fancy car and luxury house (while the docs I know who have such things have two professional incomes and one is not a primary care doctor one). Fine.

Bottom line though is that Brynda is not completely wrong. No, doctors don’t compare salaries and judge success based on income, or even on car driven. Honestly I think most are more ego driven and judge success based on the respect of their peers and the reputation they have among patients. But yes economics plays a role. The quantity based reimbursement model is a disincentive to weighing anchor when necessary. Salary models are no panacea either since, as pointed out, many docs in such circumstances have administrative bosses who are closely monitoring their productivity. A few places can pull it off with a salary model (Mayo comes to mind) but only those that occupy a particular niche in the medical ecosystem.

That said it must be noted that reimbursement systems are changing, much of it motivated by changes anticipated as the Affordable Healthcare Act starts to take effect. Doctors are becoming better at being parts of teams (teams that include NPs and PAs and others) that are getting reimbursed by the payors in part based on being able to provide various quality metrics. Spending the time to listen and to make sure that the plan is understood and followed through upon, making follow up calls, appropriately utilizing other team members, creating a real “medical home” for the patient, is then, in theory at least, incentivized, to the degree that outcomes are measurably improved as a result. Thing is that providing those metrics and compensating physicains partially based on such quality measures is difficult to do unless one is working as part of a pretty large group cooperating with a hospital or more than one and the small independent practice is going to have an even harder time in such a world.

But again, the economics is only part of why even pretty damn good doctors may sometimes seem to listen poorly. The other reasons include that having great listening skills has not been a selection criteria for medical school, that like everyone else doctors use cognitive shortcuts and sometimes use them inappropriately, and one I did not previously mention, that sometimes thinking out the diagnostic possibilities at the same time as gathering the information can be distracting. Oh, and that some are arrogant assholes.