DR. HOOK- Cross purposes: Don't take anger out on the doc

Vancouver– my kind of town! Why didn't Frank Sinatra sing something about this magnificent city? Maybe we can get Canadian crooner Michael Buble to spin a song about this Pacific Northwest gem.

I recently spent eight days in downtown Vancouver, and I only heard a car honk once (unlike NYC where cars honk as if they were members of the Mormon Tabernacle Bell Choir). Also, no one jaywalked! Even though there was a strike by civil workers, there wasn't litter. People seemed genuinely happy there, and everyone was so polite. We met an old friend who did his fellowship at UVA, and he loves practicing medicine there. His friends and other Vancouver folks all love their doctors and healthcare system. I was beginning to think everyone was a Stepford Wife.  

Are there any angry patients in Vancouver?

In medical school and residency, we learned how to deal with the "difficult management patient." The patient is not difficult– it's the management of the patient that's difficult. (I wonder who was the spin doctor on that one?) I also learned  not to get too close to patients because physicians should not lose objectivity in diagnosing, treating, and managing a patient. Come to think of it, the doctor on Little House on the Prairie– what did we know about him? See, he stayed aloof. But in a small town like that, is it really possible to say aloof from patients?

   What does a doctor do when a patient is angry– in particular, angry with the doctor? (My advice to young medical students– run!) First it's important to decipher what the patient is actually angry about, because the anger might be displaced upon the doctor. 

Is the patient angry because the receptionist mispronounced her name? Did the patient have to fight his way through traffic and arrive 15 minutes late? Maybe the patient gained 18 pounds since the last visit?  

   Often the patient is angry because of medical issues. I've been blamed plenty of times for causing the person's diabetes, hypertension, or cancer. "Doc, if you didn't tell me my cholesterol is high, my blood sugars are even higher, and my BP is even higher than that, then I'd be perfectly fine."   

   Well, nobody likes to be the bearer of bad news, not even to the Bad News Bears. But information is information, and what we do with it is what counts. So I take things in stride when someone's angry at their disease as long as they don't karate-chop me during the office visit.

   Patients in pain can be very angry because who likes to be in pain?– unless you're into S&M. I tore the ligaments in my ankle once, and when the ER doctor had to torque my ankle around, I wanted to rip his tonsils out! But I didn't yell or use his stethoscope against him.

   I have angry patients who want cheaper drugs or treatment but just as effective with few side effects. When patients are digging for spare change under the couch cushions to pay for their meds, they come back quite irritated. On the flip side, I find it interesting some Gucci-wearing patients with freshly injected Botox– to hide their angry frowns– complain about a $50 co-payment for their medicine.)

   I probably get too close to my patients, but it makes my work worth all the time and frustrations. I try to understand the underlying reasons for an angry patient and not take it personally. But sometimes I wish I could be Dr. Bombay, from Bewitched, and magically pop in and pop out.
