The Worst Patients


It is a well-known fact that “doctors and nurses make the worst patients”. But do we…? Or is it just that we are average, every-day patients who are held to a higher standard because of the high standards we place upon our patients?

So what makes me different from the average patient? I recently had to undergo a pre-employment physical in preparation for my illustrious new career as a primary care physician – which really entailed filling out a ream of paperwork then spending 5 minutes with a nurse. Anyhow, I felt perfectly content with that because I don’t have any chronic medical conditions, don’t take any medications, don’t have any risky habits, etc. It was a perfectly routine pre-employment physical for my job, because I am a perfectly average member of the upper middle class workforce.

If I were to walk into my own office a few weeks from now as a patient just to have a routine physical, I would look drastically different from 99% of the other patients on the schedule, simply because I’m generally young and healthy. If I were to walk away from the physical with instructions to take any medication every day for the rest of my life, I would probably do a sucky job at it because in my mind I have bigger fish to fry: children to raise, a household to tend, a full time job… I’ll take care of myself when I get around to it. Which means I would probably take my own pills, oh, once a week or so. Until the holidays come. Then I would have to make it my New Year’s Resolution. And we all know how those go.

The fact is that the “average patient” in a doctor’s office has chronic medical issues that require maintenance, while the average person has a life to attend to. When I see a patient in a clinical setting, nothing matters more than whatever may be amiss with his or her health. But unless I ask, how much do I know about what this person is really preoccupied with as soon as he or she leaves the building? The next time they come back, what good will it really do to hammer them about how much salt and sugar they have been consuming if their child just dropped out of school or their spouse is dying?

The sad truth is that when I see a generally healthy person as a patient for some acute clinical issue, I actually expect them to be more worried about their lives than about whatever advice I may give, so I strive to keep it simple. When I see someone who is chronically iIl, disabled, perhaps elderly and retired — that is, the average patient — all the stops come out with respect to evidence-based medicine, statistics, trials and guidelines. The recommendations are robust, and the regimens get complicated. Then I am inclined to be critical when I see them again and discover they haven’t perfectly followed my advice. Meanwhile, all these average patients really want is to go back to being average, every-day people.

And meanwhile again, as medical providers we believe the only way they can hope to have their average, every-day lives back is by being excellent patients. They have to drink all their daily pills, puff their twice-daily inhalers, self-inject their thrice-daily insulin, show up for their weekly wound checks or bi-weekly blood draws, and finally report back to me in 3 to 6 months with enough improvement to meet quality metrics. When they don’t do all of this, suddenly they become our “worst patients”. Could you do it?

And in case you were wondering whether that is what Medicine is coming to in the 21st century, the answer is YES.

Unless I can figure out a way to find out from my average patients what it would mean for them to live an outstanding, excellent life, then work on developing a plan to come as close to that as possible. Let me get started, and I’ll let you know how it turns out.