Friday, 25 January 2008

The Patient's Agenda

Any doctor, or even any patient will know that most people go to the doctors with their own agenda. A lot of the time they've got their own thoughts and ideas about what is wrong with them, sometimes they know exactly what treatment they want and occasionally they come in with the intent try and get something out of you which they don't deserve.

Its difficult to pick out these patients unless you know them and their history well and even then you can never quite be sure. Every doctor has their own 'heart sink' patients who persistently visit the doctor with chronic, often vague problems. What is their agenda I wonder? They've already been investigated up to the eyeballs, they've already tried numerous tablets with no effect, and there is little more that can be done. And so, a never ending cycle begins whereby these patients come for regular review, they're the ones that often take 25minutes even though very little can be done.

This morning I had 5 patients, and they all had pretty text book symptoms, they were all there on their own agenda and they had an idea what they wanted. I find it useful to ask what patients are most concerned about - this usually elicits exactly why they've come to see you and so you can actually help, even just by offering reassurance.

Sometimes patients trick you. I've seen this a couple of times recently. Firstly a patient came to see me and when I brought the doctor in to review the case, they denied everything as I presented their history to the doctor. I don't mean just picking up mistakes in my history I mean flat out denying that they'd ever said things to me, they ended up reporting an entirely different set of symptoms to the doctor. Why? Why would anyone do that? It made me look ridiculously stupid. I have an idea about why they did it, but still - bonkers. I seemed to remember this happened a couple of times back when I did psychiatry also, one of the reasons I despise it so much. Another patient came to see me. They seemed very unsure and nervous but I built up a good rapport and was able to find out all about the problem. I'd had a quick flick over the recent history on the computer and noticed a couple of previous visits with the same thing. So, I presented to the doctor who decided that they should be referred and off the patient went. Only after I'd dictated the referral did I take a detailed look at her past history to find that she'd been referred previously for the same thing. Shame that they'd neglected to tell me anything about their past history despite me asking specific questions about it.

So what did I learn today, well I learnt that patients really do often have their own agenda and they're often reluctant to deviate from it, so much so, that in some cases they even lie. How exactly do they expect to be treated then?

Perhaps this post is slightly hypocritical as in the past I've probably been quite selective with the truth to a doctor in order to fulfil my own agenda. That is unavoidable, I know too much about the system.


Lucy said...

I think it's important to be selective, to a point. Although, with the wealth of information on the internet now being what it is, it is possible to just type in some symptoms and out comes a varied list of possible conditions. Then choose one which seems appropriate... ta-dah! Tootle along to the GP, if necessary 'match' some of the symptoms for said condition to your own, and you can be referred to a specialist/given drugs (isn't that what everyone wants?) in no time!

Great blog btw. I hope you don't mind me adding you to my 'list of interesting blogs'.

jessica said...

Did any of your patients google their symptons??

I did once. I told my doctor and he actually snorted and laughed at me. Like I was going to believe some cult-like website that says I have some obscure disease that needs an even more obscure treatment to help.

The Shrink said...

Just a few days ago I was thinking how this happened both as a medical student when I'd get stitched up, but also now when folk present to me a history that's strikingly different from what the patient then tells me.

All part of life's rich tapestry, eh? :-)

ditzydoctor said...

it's like that isn't it? they emphasize the importance of finding out a patient's agenda but few of us actually have any time to do it. well, except for the psychiatrists - lucky them!

don't let it get you down - i'm sure you've done the best you can. :)

Calavera said...

I just left a similar comment on The Shrink's blog about this, although I've never had that happen to me to that extent before - outright lying and denying what they said in the first place!

Oh dear...

Anonymous said...

I found patients tend to generalise students as young people who all think the same. Or at least that's the impression so far.

Then again, that is a sweeping generalisation in itself...

steph said...

I'm confused as to what your agenda is here ;-)

I thought you were taught in medical school to 'listen' carefully to the patient because the first sentence uttered usually holds a clue to the diagnosis? After that, surely it's down to your own skills as a doctor/detective to decide which symptoms fit the clues and act accordingly?

I honestly feel that the patients without any agenda are the ones you most have to worry about as they are the ones with the least interest in their condition and won't come up with enough clues!

Patients tend to be much better informed these days and while many will have an ill-informed agenda, I feel that most doctors are well able to come to their own conclusions.

I suppose then you're left with the difficulty of convincing the patient that your agenda is better than theirs :-D