Sunday, October 2, 2016
I recently attended a professional conference and listened to several research reports about relationships between doctors and patients. One of the reports included in their data was from a ‘Difficult Doctor Patient Relationship Questionnaire.’ The investigator shared some of the items in this questionnaire, and I was surprised that they were all so subjective and included such negative descriptions of the patient. There were no questions about the doctor from the patient’s point of view, although I guess they would be similarly subjective and negative. Frankly, I was annoyed! this seemed to me another example of the doctor blaming the patient for being sick and having multiple sets of symptoms. It is your fault for being so complicated!
I was curious about the content of the rest of these questions, so I investigated further and found two forms - a ten item form and a 30 item form. All of the questions were consistent in only asking about a negative and very judgmental picture of the patient. Also to my surprise this ‘validated’ research instrument was published in the Journal of Clinical Epidemiology in 1994 and used in research published in the Annals of Internal Medicine in 2001 and in other reports discussing this topic.
While it might be useful to record and report the number and nature of patients who are seen in these ways by their physicians, this is only one side of the relationship equation. So, I wondered how these patients might view their physician. I changed only one word in each question - replacing “patient” with “doctor.” I’m a firm believer of not asking anything of others that we do not ask of ourselves! How would you answer these questions about your doctor or how would your patients answer these questions about you? What would it take to train or to teach doctors to not be difficult? Or is this just a product of having a bad day? or what else???
On a 1 - 5 scale, with 1 = Not at all and 5 = A Great Deal, answer the following questions:
How difficult is this doctor’s personality?
How enthusiastic to you feel about seeing this doctor?
How unreasonable were this doctor’s expectations today?
To what extent does this doctor have health related problems due to drug or alcohol abuse?
How frustrating do you find this doctor?
How upbeat did you feel after seeing this doctor today?
How negative did you feel about this visit?
To what extent are you frustrated by this doctor’s vague comments?
How demanding was this doctor today?
Do you find yourself secretly hoping this doctor will not return?
How manipulative is this doctor?
How tense did you feel when you were with this doctor today?
Does this doctor understand your explanations about physical symptoms?
How much are you looking forward to seeing this doctor’s next visit after seeing them today?
How pleased are you with your working relationship you have with this doctor?
To what extent does this doctor neglect health related self care, e.g., diet, hygiene?
How difficult is it to communicate with this doctor?
Hmm … doctors do have ‘labels’ for some patients - like heart-sink. However, heartsink is really more about the doctor’s feelings and not about the patient. Patients do not try to be difficult; they are struggling with complicated sets of symptoms and they are trying to understand their diagnosis because they do not have any relief. Their body is telling them something is wrong; sadly, their doctor (healer?) is having difficulty identifying what is wrong. The answer is not to blame the patient. At worst, listen, validate their experience and be willing to keep talking to explore possibilities. Even worse than not knowing is being left alone and then being blamed. The Difficult Doctor-Patient Relationship Questionnaire seems to be more of a measure of how much blame some doctors attribute to their most challenging patients. It may also be an indirect measure of how burnt out a doctor has become. It is a sad reflection of what can happen to both doctors and patients in a system that is not designed for the most complex patients.