I’ve been curious for some time about the arrogance and rudeness in my profession. When a new patient starts to relate her health history to me and interrupts herself with a comment like, “The so-and-so doctor was awful” (or really unpleasant or disrespectful), I inquire, “Oh? What happened?” And she’s truly glad to tell someone, especially a seemingly sympathetic member of the offending profession.
After years of listening to patient complaints about doctors, there are few surprises. Most commonly it’s a variation of “didn’t listen to me,” “didn’t take my opinions seriously,” “kept interrupting and talked down to me,” “got impatient answering my questions,” “got defensive when I challenged his/her conclusions,” or generally was visibly preoccupied with something more important than the patient in front of him.
In recent days, with huge corporations taking over physician practices, many doctors now report to an M.B.A. who places her on a time schedule and asks her to see far too many patients than quality allows. This study showed you will be interrupted eleven seconds into your visit. Many primary care practices allow only one problem to be discussed per visit. Mention another and you’re given a bum’s rush, namely another appointment (often weeks away) or lateralled to a specialist, also weeks away. Heaven forbid you bring a list of problems.
When I typed “physician arrogance” into my Google bar, I found a couple of chat rooms where doctors were defending their behavior with “We’re too rushed,” “Don’t have time to review a bunch of stuff you happened to find online,” and the supremely super-arrogant, “Like it or not, we do know what’s best for you.” I pictured these angry patients and defensive doctors like two semi-crazed terriers on opposite sides of a cyclone fence yapping furiously at each other into eternity.
To me, there are two forms of physician arrogance:
The first is the physician with one of your basic personality disorders who really shouldn’t have gone into medicine in the first place. The idea of weeding out these docs beforehand–medical damage control, so to speak–was addressed in an editorial in the British Medical Journal several years ago. It suggested that along with good grades, recommendations from professors, and the clichéd desire to help others as criteria for acceptance into medical school, every potential candidate should undergo extensive psychological testing.
Previous studies in the UK have shown that “successful” GPs (competent, respected, well-liked by patients) were rather extroverted individuals who sincerely enjoyed people and weren’t schlepping a knapsack of unresolved psychological baggage. I’ve come across no shortage of the “unresolved issues” crowd, highly introverted or narcissistic individuals who need Valium to make eye contact with their patients and who generally regard all patients as an interference to their self-absorption.
For a while I wondered how these physicians could ever build a practice and financially survive, until I realized almost all of them became salaried specialists employed by huge medical groups. As long as these doctors remained reasonably competent in their field, their behavioral problems were either not noticed or deliberately overlooked by their colleagues.
These guys virtually never got fired, and you really don’t need to be particularly friendly when you read these utterly astonishing starting salaries for specialists just completing their residencies. Hold onto your hats!
Orthopedic surgeons $600,000
Neurosurgery $700,000
Cardiac surgery $650,000 etc.,
But are they happy? Well, their production bonuses often double these numbers, so “ingratiating” doesn’t figure into this equation. The first time I had a hip replacement, the surgeon said exactly two sentences. “You’re ten minutes late.” “Which hip?” Then he turned to his nurse and said, “Schedule him for 7 AM.” I thought, “Just like 90% of all orthopedists I’ve ever known.”
The second form of physician arrogance seems an institutional phenomenon, in which a whole culture of arrogance permeates everything associated with the medical center itself, from its hospital on down through its residency training program and medical school, even including its undergraduate school if one exists. In other words, a historical arrogance passed from generation to generation, a whole self-enclosed medical/academic culture whose members are thoroughly convinced their collective digestive tracts produce odor-free feces.
Without naming names (the institutions do know who they are), anyone living in Chicago after a few years can differentiate the basic jerk institutions from the generally nice ones. Not surprisingly, these same places are often brutal to their employees and create utterly dysfunctional workplace environments. But these institutions who know who they really don’t care, do they? Of course, they wouldn’t care, they’re…Is this what tautology means?
If you’re uncertain who’s who in this regard, my suggestion for honing your arrogance-detection radar (Arro-dar for short) is to keep track of the time you spend waiting to see your doctor or waiting in an emergency room.
To me, repeatedly keeping someone waiting (and not caring) is the height of rudeness. Acknowledging that I personally have the patience of a hungry rat, I dislike waiting for anything. Keep me waiting a couple of times–maybe some sort of emergency occurred–and I can forgive. Recurring, unconscionably long waits and I’m out of there, and you should be too, because encounters like these will likely predict every subsequent visit within this institution.
If you find yourself in an emergency room and realize that you’ve knocked off a dozen chapters of War and Peace and no one has seen you, trust me, it won’t get a whole lot better once you’re admitted, lying in a hospital bed, pressing the “call button” and no one is answering. On the other hand, if you’re in a doctor’s office or ER and see a sign that reads, “Please let us know if you have been waiting longer than 15 minutes,” the whole center is being run by someone who keeps track of patient satisfaction.
As a primary care physician, my own arrogance radar is much different, based largely on how well an institution’s specialists communicate with me. You’d think that in a huge multispecialty medical center, relying very much on referred patients from us primaries, communication would be a non-issue, but this is too often not the case. From some centers after I refer a patient, I hear nothing, utter silence, the patient apparently having fallen off the planet. My inquiry calls are not returned. Occasionally, adding insult to injury, I later discover the specialist referred my patient to the institution’s own primary care department for follow-up care. “What a sh-t!” I mumble.
But at the opposite end, at really good medical centers the specialist will call or fax over the consultation notes–often within an hour of your visit–and follow up with copies of test results, x-rays, and a summary letter (often closing with a “thanks for having confidence in our institution”). All this provides me with a lot of information on how you, my patient, fared, and after all that’s what I’m here for.
Let me end this by adding: Do not tolerate physician arrogance, period. If you’re sitting in the waiting room and your longevity and good will are being chipped away reading endless back issues of People Magazine, just exit and find someone else. If you leave any encounter with a doctor feeling tense and angry from your experience, then every single time you have an appointment you’ll have a vaguely sick feeling about the potential stress ahead. Your concerns will never be adequately addressed, your questions will remain unanswered, and you’ll feel bad to boot.
This is really not healthy.
Because of rising unemployment and health insurance crises, American Medical News reported this week that people are going to their doctors less often than ever. Office visits are down. Referrals to specialists are down. Elective surgery is way down. In other words, health care is becoming a buyer’s market.
You really never again have to pay to suffer through some doctor’s arrogance.
Be well,
David Edelberg, MD
PS: At WholeHealth Chicago, we’re somewhat obsessive about being on time. Practitioners who run late get their knuckles soundly rapped at staff meetings. I hate to throw the blame back onto patients, but if you find yourself waiting in our centers, the single most common reason is that a patient scheduled earlier in the day arrived late and threw the whole day’s schedule out of whack.