Tuesday, September 04, 2007
Is my doctor listening?
Doctors might not be listening to their patients as much as they should. A new study indicates that the issue is most problematic when it comes to patients reporting side effects to their doctors. The example the study authors used were statin medications - medications used to lower cholesterol. A lot of patients may not know this, but these medications can cause muscle pain, kidney failure and liver problems. These side effects are not common, but they do happen, so the study authors decided statins would provide a good test subject.

In a survey, published in Drug Safety, many of the 650 patients who were taking statin medications and having side effects said their physician either denied or didn't commit one way or another to the relationship between the drug and the side effect. Again, these were side effects that are well known among doctors, but around a third said there was no connection. 39 percent said a connection was possible and 29 percent "neither endorsed not dismissed" the possibility of a link.

Some of the strategies to deal with this problem include keeping a diary of side effects to better illustrate the relationship between medications and reactions. Of course, as difficult as it may be, read the package inserts and ask your pharmacist, nurse and doctor about possible side effects. If your health care team still dismisses your concerns, it might be time to find a new team.

While the point of this study wasn't to determine why doctors aren't listening as much as they should, the authors did draw some conclusions. They think, for example, the pharmaceutical industry, which helps doctors with drug education, is more interested in discussing the benefits of a drug while adverse effects are less likely to be represented. Another theory is that doctors are simply inundated with side effect information on a rapidly expanding medication list, and are unable to keep up with all of them. It was also suggested some doctors are simply too arrogant to listen to their patients and too pressed for time to pay attention. What do you think the problem might be and how do you get your doctor to listen?
My husband has had a gastric by-pass. Subsequently there are many prescriptions he is unable to take. One doctor repeatly (3 times) tried to prescribe a controlled release drug to him, we have corrected her three times. This dotor is not listening, it is time to fire this doctor.
This is definitely an issue on the minds of many of us. I worry about my grandma and her various drugs. However, one possible solution I heard about at work. It's called iGuard and allows you to input your meds for safety and recall info and it can email your doc. Make them take the time to listen to you! You can find it at Google.
I had a problem with side effects from an anti-seizure medication. I went to the prescribing neurologist with my complaints. After writing up a page and a half in my chart he basically told me they were all in my mind. I left thinking that maybe I was overreacting and went on with my life. Eighteen months later I was seeing my primary care physician because I had a temperature of 105 and everything looked like a rolling tv picture. Come to find out my liver stopped filtering the drug I had complained about from my blood. The therapeutic range of the drug was 10 to 20. The level in my blood was 38. If the neurologist had listened to me I would not have had to go through weekly blood tests for eight months. I no longer see the neurologist and do not take any anti-seizure medication. As a result of this experience, I now question the doctor and pharmacist about every drug I am given. It's my body and no one cares as much about it as I do.
Just today I had a doctor enter and leave the room so quickly there was no possible time for questions. I had never seen this doctor before, had several very appropriate questions about the condition and treatment, and am not hesitant to ask. He simply provided no time. I won't be returning, but what if I had no options, if he was the only specialist allowed?
I found a similar problem with doctors who have their nurses and medical team "filter" the information from their patients too much.
I had negative side-effects from a prescription a while back. When I called to talk to my doctor about it, the nurses were very dismissive toward the problems I was having and never had a doctor call me back. I tried numerous times over the week, and finally ended up having to go sit in the waiting room demanding to talk to my doctor and refusing to talk to the nurses (who were trying VERY hard to keep me from actually seeing the doctor). It was completely absurd.
I obviously have since left that practice, and I made it very clear why I did so.
It does not matter what (in the past) I have said to or show by way of diary or log writings to doctors regarding statin pain/problems, they have always been thrown out - by the docs, as 'riddiculous'.... 'statins do NOT cause such problems' etc. Eventually through self education I have taken myself off these cruel ugly drugs, and am now using natural approaches to reducing inflammation. I follow good advice from organisations such as the Life Extension Foundation and the Weston A Price Foundadtion.

The pain is definitely reduced, however I believe there may yet be permanent damaged caused from taking multiple and high doses of these drugs over a period of years. Brain function and memory is impaired also.

I cringe every time I read another article praising these drugs and or proffering them for some other new cure.

I do wish doctors would read pages like this one and listen to their patients when they complain that statin drugs are causing them extreme distress.

Cholesterol per se is not public enemy number one.... follow the dollar.... who is profiting from the worldwide enormous sale of these ugly drugs?
One problem may be the fact that a side effect could be caused by so many different things. Television ads for medications have long lists of possible side effects, and the list seems to be the same for almost every single medicine out there. How can a doctor know that the drug he prescribed you is the sole source of your muscle pain (a vague complaint as it is), or that it is serious enough to do something about?
I am not surprised to hear this. For the past 10 years I have been sick with something several doctors have labeled "depression"-I get dizzy, my blood pressure goes all over the place, I can't eat, and I can't sleep- every doctor I have had has basically run a basic panel and said I was healthy and tried to skirt me off to a psychiatrist-3 of which have already said it is not depression or any other mental illness.
Anyway, to make a long story short, don't let your doctor feed you that kind of story-make sure you know your facts before you go, and if he/she doesn't listen, find another doctor.
Good health and luck to everyone!
I have fired 15 drs in an attempt to find the right fit for me. I have had to be my own advocate and just voice a time or two that I didn't feel they were paying attention.
If I am honest with them they at least listen when I ask them to listen. If a doctor does not have time to pay attention then I will find another doctor.
It would help if they didn't book 4 patients every 15 mins. That is an impossible goal and just makes care worse.
I recently had a drs apppointment for cysts under my arms, and I said at the start of the appointment that there were 2 more issues that I wanted to discuss, The Dr. proceeded to let me know that I was only there for the cysts. I was adamant in discussing my 2 other issues.. Birth Control and Weight Loss.. He WAS going to brush me off but I just talked anyways and come to find out that if I didnt discuss those issues he might have not come to the conclusion that I may have Poly-Cystic Ovary Syndrome..

Doctors need to LISTEN UP!!!
I was on Crestor for six months and Zocor for twenty two months. These statins have completely ravaged my muscles. I can only stand for a few minutes, can't walk very far, can hardly get up out of a chair, etc. My doctors never told me that statins could be the problem. I had to find out myself through the Internet.
The Doctors are so brainwashed and rewarded by the drug companies that they won't listen to you anymore.
I finally got my Doctors to listen by making printouts of the information and case histories that I got off the Internet and taking them to the Doctors and showing them.
If only the Doctors had listened to me in the beginning. I now fear that some of my muscle problems may be permanent.
Ask your pharmacist. Simple answer. Doctors are extremely competent people, however have many facets to a patient's healthcare to balance. With questions of side effects or other medication-related questions, there's a pharmacy on the corner of many streets in America with a pharmacist who's job it is to answer these questions. While the internet has many tools to help patients with their medication regimens, it is littered with misinformation, bias, or incomplete information.
I think Doctors are too busy and Pharm. Companies just want to make money....and frankly some doctors just don't care....I think it's clearly black and white.
I think the problem is that doctors are trained to diagnose medical problems, not to diagnose causes of medical problems. Patient says, "Doctor, my head is aching." Doctor says, "You have a headache. Take two aspirin and schedule a followup in three months."

I believe this is due the development of modern medicine in a society built on capotalism fed my a public desire for immediate gratification. Pharmaceutical companies make medicines to trat symptoms, because symptoms are more easily diagnosable. Doctors, in turn, readily use these medicines, because they make their patients feel better. FDA approved drugs also allow doctors to defer their oath to "do no harm" to the FDA. Doctor thinks, "If there is a side effect, let the FDA figure it out. They are the ones that approved it. I have no culpability."
I think doctors in general need a wakeup call. My brother was misdiagnosed several times and given medications that made him more sick. He went to another doctor who made him take expensive tests. Finally, he forced them to stop. He did his own research, found his diagnosis, showed it to the doctor, and got medication. Now he's fine. People should not diagnose themselves but what do you do when doctors just fail to listen and treat symptoms.
I have been seeing doctors for my stomach problem since the last 2 years. Most doctors do not have any interest in trying to figure out the root cause of the problem. All they seem to want to do is prescribe a medication to fix the symptom and send me packing. Patients seem to be no more than entries on a chart to be ticked off every 15 minutes until one of them land up in the ER.
Dear Dr. Sanjay Gupta,

The pharmaceutical companies "bribe" doctors to prescribe their brand of drugs to patients and usually it comes in a form of financing a patient education program in favor of the disease and the promotion of the drug that is supposedly meant to cure. This is a marketing strategy on behalf of selling drugs. People who dispise this marketing approach nickname it Madison Avenue Medicine.

I remember during an internship at a Brooklyn Hospital, that drug companies buy doctors and nurses and the rest of the medical facility staff a whole catered menu of food to promote their drugs.

Much like this is going on with the promotion fo SSRI's in which during a seminar, a local town beauty queen promotes her good mood to the use of these drugs.

Nowadays, the side-effects are quickly rattled by a narrator during drug-ads on television and radio.

Patient education should be based on "how to ask your physician the right questions," instead of asking: "prescribe me this medicine please."
To Dr. Sanjay Gupta
The Doctors just not listening the patients but they are also not doing sometimes anything to help the patient. I went true some rough times in July. In short I almost died. Just 2 days passed my 50 b-day. I went to Huntington Beach California Emergency Hospital with complain of my stomach pain. Just FYI the pain on scale of 1-10 was 500. To make a long story short, I had an US which has come positive for Acute Calculus Cholelithiasis with wall thickening and positive sonographic Murphy’s sign, concerning for acute cholecystitis.
Despite this findings yet, the Doctor sent me home with pain and tears in my eyes, and told me that I need to follow up with my family Doctor. And on the way home he’s nurse told me I need a Gallbladder Surgery soon. Soon, to turn out to be for me few hours later, after I called 91, I was immediately rush to Emergency Room in Hoag Hospital (after I refused to be taken by our Paramedics to Huntington Beach Hospital), with not letting down pain in my stomach. Little I knew after immediate triage in Hoag Hospital I was order to have Medical Emergency Surgery. This was life savings for me. Now I am trying to, cope with my effects of the treated Emergency Doctor at Huntington Beach Hospital but also with post-op complications. I also feel that is deemed necessary to tell everyone about the Hospital and the Ignorance they are showing to patients, against their own Policy which reads - “It is the Policy of Huntington Beach Hospital to treat all patients that come to the Emergency Room with the highest level of care”. Even if they do not have an insurance coverage. I am not buying that. Do you? Czeslaw Knobbe.
I too had a similar experience when I went to see my doctor. The doctor just entered the examination room and asked how I am doing. I told her all my problems and then suddenly she started writing down the medicines I had to take without explaining to me the basic reason for my unhealthy condition. Eventhough I had seen this doctor before, I really felt very bad for the doctor and the way she is treating her patients.

It is very very important that doctors should give ample time for their patients to speak out and how they are feeling while undergoing treatment under their care. Then only will they return back to you.

Two way communication between patients and doctor's is more important for understanding the symptoms and giving treatment.
What everyone is experiencing is another side effect to the proliferation of the insurance industry on medical care. Physician's are often under time constraints placed upon them by their employers, namely, see as many patients in as little time as possible. Because specialities such as family practice, pediatrics and internal medicine rely on sheer numbers of patients seen instead of performing expensive and reimburseable surgical procedures, this is the only way to turn a buck. The second problem is that because the insurance company pays the doctor, not the consumer, there is no leverage. If I get lousy service, I'll refuse to pay until someone makes it right. There is no incentive for the physician to "make it right", he'll just bill the insurance company, move on, and be done with it. Also, if you're going to fire your doctor, don't wimp out and just never come back. Leave a message for him or her to call you. When they do return the call, tell them exactly WHY you are leaving. I still think the majority of physicians care about what they're patients think about them. Hit 'em straight between the eyes with the truth.
I often wish for the old fashioned G.P. Today, there is no consistency, no "personal" touches. I feel like just another faceless yacht payment and everybody wants to do some kind of "procedure." It seems to me that the doctors are very overbooked, on purpose, with the average face time of 5 minutes and average charge for this (established patient with insurance, thank God) about $180 (Dallas area).

I have to go to 3 different doctors for 2 chronic problems (specialists) and then have the misnamed primary physician which is actually a group of three and one just takes whoever. Since my initial visit four years ago, no one has taken a BP or pulse or listened to lungs/heart or taken a chest x-ray. A request for such elicits questions if there is a specific problem and offer for ready referral to another specialists.

I am ashamed of America's health care "system" (corporation). If one is very poor or in prison, one can get free, slow and substandard care. If one is well-off, we all know more money is better insurance and better care. Most of us are caught in the middle looking for jobs with insurance benefits. When that's gone and I'm dependent on Medicare only -- Canada is going to look less cold. They may start building a fence to keep out all of us aging "boomers."
Several years ago, I went to a cardiologist that put me on Crestor .While on this drug, I became ill with peripheral neuropathy . I went off the drug, and when I returned to the Dr , I told him about my symptoms . He put me on Pravachol ,and the PN returned .This time, when I went off the drug, the PN stayed . When I saw that Cardio next time, I told him that I had peripheral neuropathy, and he got right in my face ,and said "you chronic pain sufferers are all the same, you're always trying to find something to blame it on ! " he continued to be verbally abusive to me , and I left the office extremely upset . Because of that Dr, I suffer in terrible pain 24/7 .I have to take pain meds for the rest of my life , and my life was forever altered .
I have read of the connection between migraine history and tendency to dementia later in life. How real is this connection and what, if anything, can be done to mitigate the risk? Does treating the migraine aggressively upon attack do anything to mitigate risk of dementia or is it the underlying tendency to migraine that's the culprit so that treating or not treating the headache has no effect on the eventual risk? Thanks, Angie
So what? These "studies" do nothing constructive and the results are not a surprise, especially to "us elderly." I have experienced young physicians leaving medicine when she came to the conclusion that she could make more money else where. (Both her and her associate.) HMO's are run, as you know, by non medical educated clerks. And, the lower pay and prestige of reality is not what the young doctors I have experienced expect. I also have had a turn with this statin problem with very similiar results as noted. One visit was indicative as I scheduled an appointment with the primary care physician and he sent in a nurse practicinar. When I indicated that I scheduled an appointmentwith him not her, he was very irritated that he had to come in the room. My dilemma is as one nears the end of the list of physicians, what do I do now?
I had the best doctor ever who took time to speak with me, discuss my concerns and give me advise without necesssarily prescribing medications. She has switched specialities and is unavailble to me. Since then I have dr shopped and now have 1 I like and am comfortable with. I fired 1 doctor when I told her that the medication she wanted to prescribe was one I am allergic to and she said, well ok but you only had hives the last time. We, as patients, need to be pro-active and make our concerns known. I refuse to get brushed off because he has other patients waiting.
Great insight. There are over 3 million medication errors each year with over 100,000 people dying. How do you prevent yourself from being the victim of a medication error? I do have ideas.
Bob Katz
321 Chestnut Hill Rd
Stamford, CT
You MUST be your own best helath care manager and advocate, espcially if you have chronic symptoms, especially if you were fine one day, and horrible the next. You must continue to do your own research into possible causes of your poor health and possible treatments... possibilities that most doctors would consider to be "fringe medicine," because they were never taught them in their medical training or by a pharmaceutical rep. You also must continue to move from one doctor to the next, until you find a doctor who is able and willing to think outside of the box, who is a lifetime learner, who will research the possibilities that you uncover, give his or her professional opinion on safety and efficacy, and then proceed with treatment if you and he/she agree to it.

Such doctors are out there. You have to talk to lots of people to find them. I was fortunate enough to find such a doctor after over a year-and-a-half of searching. After she absolutely nailed two different relatively uncommon illnesses that two of my children had at different times and gave them standard medical treatment that cured them, and then took my own personal two-inch thick medical history home over the weekend and proposed some possible"alternative diagnoses and treatments," I was sold. She is a keeper. Note, we still have not found a "silver-bullet" treatment, but I am beginning to feel better. But she listens to me, and is ready to take the next step WITH me in OUR search for regaining health.
Hello Dr. Gupta,

Kindest greetings from the quiet seaside of Canada. While in the midst of my volunteer work, I was involved in a car crash. The next day my family doctor came in and teased me, commenting that my medical file only had one piece of paper in it. I had been so active and healthy, probably only needing to see him once or twice since I was very young. So being a patient was all new to me.

I can truly empathize with the great distress and despair a patient feels after the anticipation of seeing a (or more than one) specialist with the hopes of some sort of answer or cure – and finding either a sad diagnosis or perhaps a vague answer.

But what can be especially painful is if our doctor seems unsympathetic or doesn’t seem to listen or even want to listen - (or in very rare cases, is verbally rough) sometimes that can actually cause greater grief than the injury itself. It’s sad to experience the meaning of the old saying “adding insult to injury”, where unkindness makes a bad situation even worse…

A person who is injured (or ill) is hyper-sensitive – it’s like having burns on your body and even the slightest touch is agonizing. If a distressed patient senses or assumes that their doctor doesn’t care it can cause great emotional pain and feelings of worthlessness. Despair is very dark and scary place to be.

On the other hand, it may comfort us to remember that we must consider our doctors too. We may not sympathetically realize that our doctors often have hundreds or even thousands of patient files. With empathy we should remind ourselves that our doctors are not super human, they have many other patients, they get tired, feel discouraged at times and have many sleepless nights.

A couple of year ago I read an article “Doctors in a Changing World” with a compelling subtitle “Doctors Under Stress.” It helped me to truly understand the stress our doctors live with and the effect it can have on them. I gave a copy of it our beloved family doctor who has been an absolute blessing to me.

It describes the great stress doctors face on a daily basis, life and death situations, giving patients ‘the bad news’, or dealing with patients venting all their anguish or fear, etc.

And eventually doctors can suffer a type of burn-out called “compassion fatigue.”

We, as patients, must keep this in mind and make the most out of every appointment. Try to help our doctor along. This really helped me. To avoid rambling, bring a list of specific questions we wish to ask our doctor and don’t feel shy to read it off. Make a list of our symptoms and kindly offer it to our doctor to consider. (many specialists will actually thank you for this) And mark down our diagnosis and anything our doctor tells us.

Do everything we can to make sure that after we leave your appointment we don’t have that startling awful moment when we say to ourselves: “Oh no! I forgot to tell my doctor something!”

No matter what, we can’t give up in trying to find the answers that we need to feel better. We owe it to ourselves to get the best care possible for ourselves.

On a side note, I also feel that it’s so important not to forget to show gratitude to our doctors, to send a kind “thank you” card after, or a little gift – something to show that we truly appreciate them. Burn-out is often the result of feeling unappreciated. A kind thank you may give our doctor (or doctors) the boost he or she needs to carry on in their noble profession. What would we do without them?

You are obviously a truly kind and caring doctor Dr. Gupta, thank you and keep up the good work. Wishing you many blessings.

In appreciation, AretiGina by the sea in Canada

Life is beautiful........"What do we live for, if not to make the world less difficult for each other?" ~~George Eliot (1819-1880)
As a physician, I can say that there certainly are docs out there that have difficulty listening to their patients or simply don't have time. BUT, I would say the bigger problem has to do with the enormous amount of resources 5% of the patient population takes up. To be frank, we don't have time to read through your 10 pages of everything you felt in terms of pain, etc. over the last two weeks. In addition, when you don't get to the point fast enough, we don't have time to sit and listen to a 20 minute circumferential report. It's not against you as the patient, but you must realize that there are many other patients in addition to yourself and very limited resources in terms of doctor time available. Perhaps if we made more money per pt than we would have to see less patients, you can thank your gov't, insurance companies, and lawyers for this.
I just posted a comment above (I am a physician) and wanted to add just one more statement. Please do not spread word that a particular medication is horrible and no one should ever take it just because you had a reaction to it. Statins are truly revolutionary and have literally saved hundreds of thousands if not millions of lives. If 1 out of 40 patients cannot tolerate the statin, then so be it. But there are still 39 others who it may extend their live or even save it. Please remember that you didn't go to medical school and don't know everything. Anecdotes are not evidence and your experiences are not the same as everyone elses. Consider this.
I've been pretty lucky, judging by the other comments here. I always go to my docs with a written list of questions, and plug away until they are answered. My only problems have been with my primary care physician. I think that he's just swamped and seeing too many patients each day.I often have see a PA instead if I want an appointment within the week. While helpful for routine matters such as a sore throat or a mild laceration, a PA is no substitutue for a doc. We need more primary care physicians, but they seem to be diminishing in number; I've been told that their reimbursement rates are very low by comparison to specialists, and that fewer med students are going into primary care.
I'd like to encourage caregivers to visit CareShare at http://forums.delphiforums.com/careshare. CareShare is an online forum where caregivers can ask, share, inform...and even gripe. Encourage others; help yourself.

I started CareShare in 2001, about a year after my mother was diagnosed with Alzheimer's disease. This was back in the "stone age", before blogs were all the rage, cell phones were just for making phone calls, and a blackberry was just a fruit. Six years later more people than ever before can email anytime from anywhere.
Can't think of a better use for that technology than to offer or receive support.

Caregivers are a great resource for one another. We know what its like to worry about a parent's memory loss, a spouse's test result, or home care costs. So who better to turn to than other caregivers who can relate to these experiences. Besides, an objective ear, an open heart, and some common sense can go a long way. Caregiving is tough enough. Why go through it alone?
And as I'm sure you know, caregiving is rarely 9-5. Frankly, I've done some of my best worrying around 3am. Perhaps its not a convenient time to call a friend for support, but its as good time as any to post a message on CareShare. By the way, it's a free service.

Maybe cellphones have changed over the last six years, but caregiving issues remain the same. I hope that people will visit CareShare and start a discussion, contribute to the conversation, and find some comfort too.
I was given statins by my regular doctor before I left to work overseas for a two-year assignment. On my second year I started having muscle pain on my leg, hips, back. The doctor attributed that to a family tendency to osteoporosis and arthritis. I have always had normal to low blood presure, but at this time I had an irregular electrocardiogram. The cardiologist said I needed a heart catheterization, which had to be done in the States a few months later. In the meantime, I was given Plavix and Maxitrol. At this time I became very sick, run out of breath easily, could hardly walk more than a couple of blocks before having a sharp pain in my heart and throat. Returning to the States, before I had my catheterization, I quit taking all my heart medicines and felt immediately better. The cardiologist said that nothing was wrong with my heart but that I should continue to take medicines to lower my blood pressure. At this time I traveled to another State to visit my regular Dr. He said that my blood pressure was low and asked me not to take any medicines without the Dr. proving that I needed them. I continued to take Zocor until I realized that the heart is a muscle and that it was possible that the heart pain was caused by the statins. The doctors do not want to admit this possibility. It might be rare, but it does happen.
I was taking VYTORIN and developed an overwhelming itchy rash all over my upper torso and extreme muscle aches. My doctor flatly refused to believe it was from the drug. I have switched to Crestor and have had no side effects.
Most doctors don't listen even when the patient is giving them information needed to treat them. I recently changed medical groups and told my new doctor "I'm having severe pain in my neck and upper back/shoulder area. My father had a degenerative bone disease that affected him in the same area." Her comment was "oh, it's probably just arthritis. Take some ibprofen and see if that helps." Several years ago, I asked a doctor when he would start checking my heart since I have a family history of heart disease and I was in my early 40's. His reply was "oh women don't get heart disease so you don't need to worry". Every day, on my way to work, I drove by a huge billboard which said "Heart disease is now the Number One killer of women in the United States". I changed doctors. The state of health care in this country has gotten so bad that a patient has to read as much as they can, be well informed and be willing to change doctors to get the proper treatment. It scares to me to think of where we'll be in another 10 years.
I agree with all of the comments posted above: doctors are overworked and rely on the folks who are making the drugs to "educate" them about it. I was taking a medication that made me vomit, feel lethargic, and lose weight. I had to find out these were common side effects on the Internet.

It is unethical and immoral that heath insurance companies operate at a profit. I hope the next time Americans have a choice to change our health care system, we will not be fooled by big pharma and other money grabbers who will try to scare us by calling it "socialized medicine". Our healthcare system is broken, people are dying and suffering for the sake of profit; the wealthiest 5% just keeps getting richer. The system will not change until we demand change.
Doctor's are trained not to listen. They are, omnipotent and all knowing - what does a patient know anyway...

it's time we re-assess what our Doctors really are and are not!
First, let me say that we are blessed in this country to have the medical care we do. After travelling to the Caribbean to adopt a baby we saw what it was like to be lacking basic health care.

Doctors are like any other profession. Personalities make a big difference. I have had good and bad doctors. I left one doctor after he repeatedly ignored what I was saying and made callous comments. I took myself off from an asthma medication after having heart issues that were dismissed and suggested to be mental. I knew the symptoms were from the medication. People have died on it and I could have been a statistic. He also did not make it a priority to prescribe safer medications while I was pregnant. I was forced to do my own research.

With that being said, there are good, caring doctors out there. I am thankful for the medical care we do have. Even though it is not perfect, it is much better than what much of the world enjoys.
At 6:21 a poster claming (credibly) to be a doctor wrote:

“we don't have time to read …”
“we don't have time to sit and listen …”
“you must realize that there are many other patients …”
“Perhaps if we made more money per pt than we would have to see less patients …”

It is due to doctors like you that I had diabetes for fifteen years before they figured it out despite classic symptoms of constant exhaustion, chronic infections that wouldn’t heal, an extensive family history of diabetes, and a blood sugar of 285. One of them wrote sarcastic notes in my chart that sound similar to your complaints. Now I am disabled, and I will trade my house and income for yours, sight unseen.

The same person posted:
” Please do not spread word that a particular medication is horrible …”

My warnings about statin drugs came straight from (1) my own gut instincts, and (2) my own insurance company. Hospitals kill more people every year than guns do, and you need to get that straight. Anything else causing 100,000 fatalities a year would be immediately outlawed. Drugs kill, cripple, and maim people too. It’s called “reality,” and it exists whether or not you like it.

The same person wrote:
“Please remember that you didn't go to medical school and don't know everything.”

Yes, and you please remember that until you sit still and listen to a patient, you don’t know ANYTHING about him or her.

Finally, the same person wrote:
“Anecdotes are not evidence and your experiences are not the same as everyone elses.”

Where did you learn science? Anecdotes certainly are a form of evidence, just as your own attitude is a form of evidence of doctors’ arrogance. For you, my friend, I recommend (1) Prozac, (2) quit drinking, (3) start exercising, (4) go to church, (5) talk to a friend or preferably a professional social worker about all the other things bothering you, and (6) change professions. BTW, my "anecdotal" knowledge about physicians came from scientific evidence I gathered during my masters research.

James Shirley
Easley, South Carolina
I had a good pediatrician for myself growing up, he would always communicate with us children and teenagers. Not only did he make sure the medications were taken properly, he would also make sure the hospitals we sent us to and the pharmacies we obtained our medicines from were safe. If anything seemed to be a matter of disciussion he would talk with us and our parents. You don't get that too often nowadays.

PS Unfortunately we have too few doctors in our country; many have been scared off due to the malicious practice of suing doctors because they made ONE mistake. Who wants to work in an industry if they can get sued that easily?!
To the anonymously posting physician:

Wow. I would hate to be one of your patients. The type of arrogance and "compassion fatigue" present in your two posts represents EXACTLY the sentiment that so many posters on this blog are expressing. If this sort of anger lies behind the "how can I help you today?" when you walk in to first greet a patient on his/her visit, then perhaps you need to consider a career change.

To be fair, you certainly are correct. The vast majority of your patients (perhaps even all) are not physicians. They have no where near the highly specialized years of training that you have. (Perhaps a quarter to a fifth of your entire lifetime!) And that holds true for even the most knowledgeable "laymen."

To be frank with you, it is incumbant upon YOU to cut through the "10 pages of everything" that, undoubtedly, some patients bring to their office visits. If you don't have the time to listen to a patient's "circumferential report" then you need to better manage your patient. You need to cut through the clutter and get to the heart of the problem.

If you don't like that - tough. This is the screwed up system we have. And it's not going to change anytime soon. I agree with you that doctors are seeing far too many patients in a far too compressed amount of time. And I agree that there are far too many lawsuit happy lawyers (and some patients) out there, as well as a insurance company driven healthcare system that ultimately leaves both doctor and patient feeling the burden.

But, as I said before, this is the system we have. Doctors need to accept the current reality. They need to know that their primacy WILL be challenged (and that's got to be an especially bitter reality check for long practicing physicians). They need to accept the lower pay, the time constraints, and the reality that they can't just diagnose and treat in a vaccuum. They must provide palliative care. Unfortunately, that's contrary to the mantra of the medical school system.

Please also keep in mind that many patients are not good self advocates, due to many differing factors. And for many, the one physician who they're "unloading on" (and I can empathize with your frustration when that happens) is the only physician they're able to see. That's neither the fault of the physician or the patient, but physicians need to be able to accept and adjust to this reality.

And from my personal experience, even when I've gone to some physicians - knowing this to be the current reality - and I keep both the description of my complaint and my questions succinct, I've still been given the brush off. When that happens, I seek out a new physician, which I'm exceedingly fortunate enough to be able to do. Some patients could be so lucky.
My doctor was shocked that I'd signed up to a service that sends both him and me safety alerts and updates about my medicines... But not as much as I was to learn that my statin had an "orange" risk rating because of a potential interaction with another drug I'm taking. My doctor's response - "I didnt want to worry you!"

Its a sad day when we can get more respect from an online service than from a doctor!!
As a physician, I hear many times that doctors don't spend enough time with their patients...even from my own family. But between pharmacy phone calls, paperwork for patients, social work intervention, insurance authorizations and denials (this is a big one) and the need to schedule 2-3 patients for the same block of time in order to make ends meet to run an office, it is hard to spend the time you want with your patients....it is one of the reasons why i left primary care. We try to listen as much as we can but really there is only so much time in the day.....if you want personalized care with no time limit, unfortunately, you've either got to go fee for service (and not deal with insurance companies) or hire your own personal physician.
I have had several frustrating encounters with "disconnected" doctors. I fired one doctor because he was scheduling 5 minute (that's right, intentionally) appointments and charging me and the insurance company full price. Trust me, when that 5 minutes was up, you were out. He did it to simply prescribe meds and move on. No way you could actually speak to him during that time. I also am close to firing my current doctor. They too have "filtering" staff that are not nearly knowledgeable enough to be taking front line calls from patients all by themselves. So many times I've asked for a prescription refill only to be told they never prescribed that med for me. Then I have to call back and explain that what they might have on the chart is the brand name, and I have the generic. Should I really be the one to know this trivial difference in drug names? How hard would it be to think that one through? Add to the mix the HMO paperwork. Getting a referral is a major pain and I have had a few appts over the years where I show up but the referral was never done, and they are ready to turn me away.

Then, of course, is the specialist. The one that takes a truckload of HMO paperwork to even get to see, only to have to wait sometimes for months...then they spend all of 2 minutes with you and rush you out the door, not leaving even a second for a question.

Bottom line is that our medical system is broken. I don't know who's to blame, managed care or a generation of doctors that are indifferent to human suffering. In so many cases, all it would take is sitting down with the patient, listening to them, looking them in the eye and making them feel like the time and money that was exhausted to get to them was appreciated.
We do live in the age of entitlement don't we? Everyone wants a personal physician at their beck and call 24 hours a days 7 days a week. That physician should be able to correctly diagnose everything and never be wrong. Athletes with multimillion dollar salaries can drop touchdown passes, miss lay-ups or drop pop-up flies, but forbid a physician miss a diagnosis because somewhere, there is a sleazy lawyer waiting to cash in. I guess it's also asking too much that patients know their medical history.

Physicians are not perfect, nor will they ever be. The real world isn't "House", where there is always a diagnosis. And in today's world, you will not find a primary care provider who can spend 30-45 minutes listening to every complaint. It's impossible. One can't see 40 patients a day spending that much time with every individual, just do the math. Many patients don't relize that their physician has already spent 20-30 minutes reading through a stack of radiology reports, labs, EKGs, and consultant notes before they even step into the room. Afer they leave the room, more time can be spent requesting additional reports and looking at films, calling consultants, all for the patients benefit.

The reciprocal question can be asked, "Are patients listening to their doctors?" How many of you have quit smoking, lost weight, avoided sweets to help control your diabetes? I can tell you right now, not many. How many patients have put off surgery or not taken medications because they didn't feel they were necessary, only to represent when the problem is much worse?

Granted, there are some physicians who are arrogant and don't want to listen, but these are the minority. I can't understand why someone who has spent 7-15 years of additional training after college doesn't agree with your opinion, because you are the expert; you read 1 article posted on who know's what web page and that makes you all-knowing.
As for the statins, yes they do have side effects. But they are also responsible for keeping many of you smoking, obese, non-compliant diabetics alive. In fact, many people are kept alive when only 50 years ago if they had the same problems they would have died.

There's a lot we know and can treat today in medicine, but guess what, there's even more we don't know and can't treat.

Patients are getting sicker, older, and much fatter (making them higher risk) and medical malpractice insurance is getting more expensive as physicians are getting paid less to take care of these more complex cases.

I am calloused. That young, naive, altruistic medical student is dead and gone. When I get called from the emergency department at 2:30 in the morning when someone needs emergency surgery or they could die, I may not be the epitome of happiness when you see me. But, I did get up and come in to see you regardless of your insurance status, because you need to be treated and that's what I do. And I'll do everything I can to make sure you get the best quality of care to get you through your illness. I will take in to account your desires regarding treatment versus quality of life. But I am not a god. Sometimes (blank) happens, and there is nothing I can do about. It doesn't mean that I messed up, or that malpractice occurred,it just happened. And it always can. Every patient, every case, every day, it's possible. Try sleeping at night knowing that.

I heard on physician say it best:
At no point in history have we ever been able to do more for people who are more ungrateful for what we do for them.

I could go on and on, but I'll stop.

By the way, I'm not a physician, or a surgeon.
I'm a human lottery ticket.
My prayer tonight... that the poor burned out doctor who posted that last comment, and ironically complains about not having enough time to see patients yet apparently has plenty of time to read and respond to blogs on the Internet, should retire or go into a backoffice medical field FAR FAR FAR AWAY from human contact...then seek some behavioral health assistance to rid themselves of their seared conscience.
I just watched a PA prescribe medication for my mother-in-law that was clearly flagged by the computer as contraindicated with the other meds she was taking. My mother-in-law almost died because she was unaware of this.

I think the reason was the PA was rushed to see the next patient. Doctors must fulfill a certain number of patients in an hour or their pay gets docked. I think this promotes listening less and not paying attention.

I know one doctor who's "solved" this problem by coming early, skipping lunch, and staying late so that he can see his patients in as much time as he feels they really need.

Gone are the good ol' days of doctors caring for their patients the way they'd want to.
From what I read in overseas magazines doctors are supposed to welcome patient participation. However, here in South Africa many doctors seem to be threatened by patients who take responsibility for their own health. The doctors I know don't want to discuss side effects - they take it for granted that a patient will imagine all sorts of problems if he or she is warned about possible side effects. There is very little communication and if you dare to question the doctor, you are seen as a 'difficult' patient. I find this to be a frustrating and often frightening situation. Health care should be a team effort - after all, it is my body, isn't it?
I am in a situation that is causing me to avoid mt PCP (primary care physician). I have been seing him for many years, he has become immune to hearing me.
He is a member of the largest physicians group in our area. When I inquired about changing it seems there is the requirment to have my current md give a letter of agreement to release me to another md in the group and then a letter from the doctor considering assuming my care. The catch for me I am on medicare due to a disability and inquiries to other practices results in turning me down due to the level of reimbursement. Any suggestions?
I could write volumes regarding the fact that doctor's don't listen. I spent more than 12 years, going from doctor to doctor, describing my symptoms. I was written off as a hypochondriac, a person that had an anxiety syndrome, etc. Everytime I would bring up some of my symptoms, my internist would just shake his head and not really listen. When I told him I was going to see an Endocrinologist, he thought I was wasting my time. The first endo treated me for hyperthyroidism caused by "hot nodules" but I continued to have problems. When I told her that something wasn't right her reply was "I don't know what to suggest." So, I started playing with my medication doses myself. When I told my internist I was going for a second opinion, he rolled his eyes. Second diagnosis...Hashimoto's autoimmune disease with episodes of Hashitoxicosis. I am now going for a third opinion because there is still a problem that seems to involve my adrenal glands and no one will attempt to diagnose it. I am really fed up with the medical establishment. I walk into their offices and plead for help and they just turn away.
The system is overburdened, and I get the feeling that it's not the doctors themselves that are entirely at fault. Health care is a business nowadays- "time is money". Insurance companies have taken the most precious aspect of our lives and used it to make money. And no, it's not right. Doctors are under the gun and many are leaving the profession altogether.

That being said, as a young patient, I do feel that some of these doctors subconsciously discriminate against their patients in terms of age or type of problem to keep things moving. For years, I experienced overwhelming fatigue and occasional breathing difficulties. For someone my age, this is definitely a huge red flag, and yet, I was blown off by my doctors. Then the problem became severe and to make a long story short, I was diagnosed with a heart defect that had done so much damage over the years, my heart had started to fail. Keep in mind that I was healthy in every other way. If any one had listened to me in the first place when I was a teenager, it might not have gotten to this point. So my caution is this- if you feel you're being disciminated against because of your age, change doctors, because it could be something serious. Don't let anybody trick you into thinking your problems are in your mind. You really do have to be your own advocate, especially in light of the direction medicine has taken. In the end, it was my mother, a registered nurse who loves and cares about me, that picked up on the fact that my symptoms were consistent with heart failure- not my physician. Only then did I see a cardiologist, who ordered appropriate tests.
With all the criticism (valid, no doubt), I just thought I would add a positive comment. I am lucky to have had a physician (until a recent move) who listened, never interrupted me and takes as much time as is needed. It's even possible to ask for a longer time-slot (30 mins if needed) when making an appointment. He's a great doc, but I know for a fact that he's not in it for the money, so he's by no means rich.

On the other hand... he's truly a rare example out there, for I am having a really tough time finding a doctor even remotely like in my new home town.
I have used my family doctor since 1983 when I went to him while I was pregnaut and had developed extreme heartburn. He told me that it was commong with being pregnaut and would go away. It didnt but I could deal with. I always thought that he was a great doctor until in 2006 I started having problems with my heart and specialists started putting me on huge amounts of medicines. I became sick all of the time and was vomiting acid/bile. I was going to him approximately ever 2 weeks for help. It had gotten to the point that I would have to have a glass a water to drink because it would burn so badly when I would be sick. He would give me all types of medicines for the stomach and finally last week sent me to a gastro specialist. I could not understand why this specialist was so rude to me. I was hurt and more than a little upset. I had requested my medical file from my family doctor and received them the day after my gastro visit. I was horrified at the report. There was a fax to the gastro specialist that said that I was convinced that my stomach problems was caused by the medicines that I was taking for my heart/blood pressure problems. That is NOT what I said. I asked him if the medicine/combination of medicines could be causing the problem. He also wrote that he seriously did not think I had any vomiting issues because I was not loosing any weight. That is NOT true because going back through my file HE had my weight loss charted every time I came in and it shows that I have lost 30lbs over a 3 month time period. He wrote that I was obviously not taking my stomach medicines because the problem persists. NOT TRUE. I tried every medicine that he gave, even the ones that made it worse. I am so hurt and upset. Not only has he violated my trust in him but he has also wrecked a relationship with the gastro doctor before it even started. After blood work, scopes and scans it was determined that I have h. pylori, hiatal hernia, peptic ulcer, barrets esophagus and gastroesophageal reflux disease. Could some of this been stopped from happening if he would of just listenend to me? Probably. Now I will never completely trust a doctor again. How horrible to completely twist what you say in your discussions with them. Not just this time but continually through the entire 24 years that I thought he was wonderful. Horrible. Everyone should request their reports to see what is truely being said about them.
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