For Doctors: Doctors Behaving Badly

Let me start this post by saying this loud and clear: Absolutely none of the examples I give here involve my current doctors. My current doctors are amazing. They set the standard for how doctors should interact with their patients.

I should also note that I am generally pro-doctor.

I respect the fact that doctors go through the amount of schooling and training they go through. Even though I’m a pretty savvy patient, I don’t get into the idea that I know more than a doctor does… unless a particular doctor gives me good reason to think that.

I also know that doctors are still human.

Even the best doctors are going to make mistakes. Great doctors are going to have bad days. Being a doctor isn’t easy. I am absolutely aware of that.

However… there definitely are bad doctors out there. There are average doctors who have treated patients poorly. There are issues with hubris, countertransference, and bias. There are doctors who blatantly ignore established protocols, doctors who ignore written orders from other doctors, and doctors who vent their frustrations on their patients.

Why does this matter?

A doctor treating a patient poorly can be genuinely traumatizing for the patient. There is a power differential at play. Doctors wield an incredible amount of power, and patients are often at their doctor’s mercy. Even something seemingly minor like dismissing symptoms can be traumatic. The patient starts to question their own experience of their body. My therapist and I have joked that – while I’m not a hypochondriac – I might be a hypochondriac about being a hypochondriac. Why? Because I had so many previous doctors ignore or dismiss symptoms. Those symptoms never went away, and I was later diagnosed with conditions – some serious – that perfectly explained what was going on. But even with solid diagnoses, I still question whether or not I’m actually feeling a particular symptom. That uncertainty makes it difficult for me to communicate with my current team of doctors.

So what kind of negative experiences are we talking about? Here are some examples from my own journey as a patient:

  • I’ve been called “dramatic” for simply sharing symptoms. An urgent care doctor was going through my medical history and got to allergies. I asked if he needed to know food allergies. He said yes, so I told him I’m allergic to shellfish. He asked, “How bad?”, so I told him it was severe. He rolled his eyes and asked what my symptoms were. I started to list off things like difficulty breathing, total body hives, GI upset… when he cut me off and said, “Oh, I think we’re being a bit dramatic!” He marked my shellfish allergy as ‘mild’. For the record, I was only at urgent care to get a splint for a clearly sprained ankle. I have no idea why he took issue with my food allergy.
  • I have had so many doctors who didn’t handle my medical history well. I had one doctor tell me, “You can’t possibly have this many things wrong with you”. I can’t tell you how tempting it was to say, “You know what, you’re right! Let’s start crossing stuff off. I don’t have this anymore and I don’t have that anymore. Let’s definitely cross off the autoimmune disease because, hey, who wants that?” I’ve had doctors sigh deeply and slump over as I went through my medical history. That makes it pretty clear that my medical history is a hardship for doctors. Sorry. I didn’t ask for this, either! That kind of behavior makes me nervous about sharing my full medical history with new doctors. These days, I just hand over a sheet of paper with a list of my conditions and my medications. Before I did that, however, I would frequently leave out bits and pieces of my medical history because I didn’t want to be seen as a “difficult case”.
  • I’ve been scolded for using certain words. I used a medical term, and one doctor said, “Ah ah! Don’t use those words! We use those words!” I’m an adult who had once been on track to go to an advanced nursing program. I’m not a toddler who needs to be corrected. Patients like me are usually familiar with medical terms because we have to be if we’re going to understand what’s going on. But what does that do to a patient? First, it creates distance between the patient and doctor. That doctor was reinforcing a hierarchy. I was being put in my place. It also changed how I communicate with other doctors. Sometimes I find myself fumbling for words because – while I know a medical term that would perfectly explain everything – I’m more hesitant to use medical terms these days.
  • I’ve had potentially serious situations downplayed. Before I was diagnosed with cyclic vomiting syndrome, I happened to have an appointment with my (then) primary doctor on a day when I was in an active episode. By that point, I’d vomited out everything possible and had had so much diarrhea that nothing else was coming out, so I was just dry heaving and sometimes bringing up bile. The doctor decided to give me an IV for dehydration. Great! Except I was so dehydrated that multiple nurses, the in-office phlebotomist, and the MA who moonlit as a medic couldn’t get an IV in me (I’m always an easy stick, so that should have been a red flag). Their solution? Force me to drink warm ginger ale. Thankfully, my episodes usually lasted 12 hours, and we were right at the 12 hour mark. We sat in the exam room for what felt like forever with the staff getting increasingly irritated as I slowly sipped the ginger ale. “You’ll feel better sooner if you can just get that down faster”. I finally got the ginger ale down, they tried again with the IV, got it going… and then sent me home declaring me cured. Honestly, I think they just got lucky with the timing of the episode and the fact that I normally have great veins.
  • I’ve had my diagnoses harshly questioned and my current doctors disrespected. It’s one thing to disagree with another doctor. It’s something else entirely to disrespect another doctor to one of their current patients. Yes, it impacts the patient. First, if having “too many” things wrong with us is grounds for our current doctors to be disrespected, we might edit our medical history and leave things out. Second, another doctor setting themselves up as superior to a current doctor and harshly criticizing a current doctor’s diagnosis undermines the trust the patient has in their doctor. We can’t help but wonder, “Maybe my doctor does have it all wrong”. Trust is always important in any doctor-patient relationship, but it is absolutely critical for a patient who has a complex medical picture. We have a lot going on. It’s overwhelming. Navigating the medical world as a complex patient is scary. Being able to trust our current providers gives us a sense of safety that is crucial to our mental and emotional well-being. Again, I’m not referring to one doctor disagreeing with another. I’m talking about harsh criticism and blatant disrespect.
  • I’ve been treated like a drug addict in more ways than one. I had one doctor list off a bunch of controlled medications he wanted to prescribe and then ask if I had any preferred brands. I stopped him and said, “Wait, what’s your diagnosis?” He laughed and said, “Oh, we don’t diagnose these things”. I think that was more disturbing than all of the times doctors refused to help me because they thought I was a drug seeker.
  • I’ve been treated like I was overreacting even though I was following medical orders. That actually happens a lot. The most striking example: I’m an asthmatic and had a chest cold, so I went to the ER when my peak flow readings were consistently low after taking my inhaler. Under the direction of the primary doctor I had at the time, I had already been to the ER earlier that week for the same reason. At my first ER visit, they took chest x-rays, gave me a nebulizer treatment, and put me on a steroid pack plus antibiotics to knock out the chest cold and calm my asthma down. They also instructed me to come back if I had any more issues. I did… but I got a completely different doctor. No x-ray. No nebulizer. I handed him my sheet of paper showing my low peak flow readings. He made a display of crumpling it up before he angrily threw it in the trash. Then he sent down someone from respiratory therapy to show me how to use an inhaler. I’ve known how to correctly use an inhaler since I was 6 years-old. My elementary school nurse used to call me down to her office any time a student was newly diagnosed with asthma. The school nurse would have 6 year-old me show the other student how to correctly use an inhaler. The only instruction I got from the ER was to follow up with a pulmonologist. I called everyone in the phone book until I got an appointment the next day. At the appointment with the pulmonologist, my spirometry reading came back low… and he said, “Oh, come on! You’re not even trying!” I’ve been doing spirometry testing since I was 14. I know how it works and I would never sabotage a test. Failing a test usually means more tests or medications, and I’d rather not deal with all of that. The pulmonologist put me on Advair, gave me a sample, and had me take the first dose in his office. On the way home, I started coughing up so much thick green phlegm that I had to pull over because I was gagging. I don’t know why my pulseox came back normal when I clearly had some kind of lung infection. I don’t know why I wasn’t wheezing. I do know that I stopped checking my peak flow readings for over a decade. What’s the point if a doctor is just going to throw it in the trash? I also know that the next doctor who had me do spirometry testing said, “Well I don’t think we can say you weren’t trying!”
  • I had a doctor laugh at me and tell my mother I was just being a dramatic teenager when I went to him because my fingertips kept turning blue. I was later diagnosed with Raynaud’s.
  • I had a doctor tell me, “You must be lying”. I was asking why he thought my stomach was showing signs of inflammation in a biopsy. He said, “You’re probably taking a lot of NSAIDs”. I told him I rarely took NSAIDs because I know chronic use can cause problems. He just shrugged, “You must be lying”. Needless to say, I got a new gastroenterologist.

Again… why does this matter? After all, a lot of these examples seem like nothing compared to some of the horror stories I’ve heard. That’s actually my point. It doesn’t take a big event for a patient to be affected by a negative experience with a doctor. It’s also important to remember that a lot of seemingly minor bad experiences can have a cumulative effect.

Even if you would never treat a patient like that, keep things like this in mind.

Experiences with previous doctors impact how a patient interacts with their current doctors. If you have a patient with multiple chronic conditions, they’ve probably had more bad experiences than the average patient. If you have a patient with any unusual or legitimately rare conditions, their number of bad experiences is going to be exponentially higher.