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You should keep your own records. At the very least, you should
have a copy of your most recent medical history and physical examina-
tion, of all hospital discharge summaries, and of the results of any major
tests or procedures you have had (such as CAT scans, treadmill tests, or
heart catheterizations).
The effective patient doesn't allow the health care system to put in
danger his health by losing his records. Instead, he gets copies of those
records him, and keeps his files up to date. Doctors and hospitals often
don't want to release medical records to patients themselves (fearing liti-
gation), but the information stored in those
records belongs to the
patient, and the patient has every right to them. Your doctor, of all peo-
ple, should understand this, and if you've chosen your doctor wisely, he
will help you obtain the records you need.
4. Difficult patients
Some doctors are just frustrated. They can't solve a diagnosis or
find a treatment option that works well for the patient, and they no lon-
ger want to treat the patient due to that frustration. Although this com-
plaint is more a reflection on the doctor than on the patient, it is likely
the patient is frustrated by the doctor's inability to do her job, too. That
may lead to an extreme reaction on the part of the patient, fueling the
fire.
Some patients don't
pay their medical bills, yet they are surprised
when a doctor doesn't want to spend time with them any further. Ima-
gine a boss refusing to give a paycheck to an employee for the hours that
employee put into his job. That's how doctors feel when they don't get
paid for their work, too.
Sometimes doctors refuse to see patients out of a belief that a disea-
se doesn't exist. Patients who have been diagnosed with diseases like
fibromyalgia or chronic fatigue have been refused treatment by doctors
who do not believe those are 'real' diagnoses.
Some doctors just don't want to work with empowered patients.
They can be bothered, or they are intimidated. Doctor didn't want to deal
with someone who was doing her own research.
Doctors risk arrest and loss of their licenses to practice when they
over-prescribe pain meds. Many patients who are in real pain have trou-
ble finding doctors who can help them because doctors fear prescribing
the drugs these individuals need.
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Patients need to be aware of the reasons a doctor might deny them
the care they seek. Awareness of our own
behaviors helps us take the
first steps toward repairing the relationship with our doctors, and provi-
ding us with a better chance of getting access to the care we need.
Difficult patients
, who can vex even the most mild-mannered physi-
cians, span the spectrum of challenging behavior. Some specialize in
self-diagnosis, demanding unnecessary tests and medication. Others
monopolize your time and energy or they verbally abuse the staff. Amid
the many in your patient population
who are gratifying to treat, these
few rabble-rousers can make you wonder why you ever got into the
business of healing. They complain,
criticize, shout, swear and may
even try to hit you. Difficult patients are an unfortunate fact of life in
healthcare. But knowing how to identify,
understand and respond to
them can make your work life safer and less stressful.
Feeling angry, frustrated, guilty or defeated at the end of some
consultations is an experience common to all doctors. These emotions
are more often provoked by patients labelled 'difficult', 'heartsink' or
even 'hateful'. These terms ('heartsink patient' in particular) have become
politically incorrect as they imply judgement (and blame) on the patient,
are offensive to the patient and ignore the fact that the emotions genera-
ted are the consequence of a complex interplay between patient, doctor
and healthcare system. This view claims that
difficult patients do not
exist, only difficult consultations. The fact remains that certain patients
tend to have difficult consultations more often than others and that ref-
lecting on. Isolation and fear can lead to anger, which can escalate into
violence. "Look for isolated patients who are cut off from their families
and communities," says Simms, a clinical specialist in adult and family
mental health nursing.
While numerous classifications of difficult patients actually exist,
some types are widespread as following:
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