July 12th, 2011

A Thank You to Nice Patients

Yesterday I saw one of my favorite long-term patients. She’s just wonderful, and it’s always a joy to see her. Here are some reasons:

  • She’s uniformly nice — not just to me, but to all the nurses and social workers and other support staff in our clinic.
  • She shows up on time for her appointments. Love that.
  • She’s highly involved in her care, but doesn’t try to make all the decisions. Example:  when I proposed a medication change a few years back, she asked many thoughtful questions about the pros and cons of the change I was recommending. But she didn’t then come back with reams of internet research questioning everything we’d already discussed. In other words, she gets it that I do this full time for a living, which means that she doesn’t have to do the same.
  • Even though her kids call her all the time on her cell phone, she cuts the conversations short during our encounters. Then she politely apologizes for the interruption.
  • She’s very appreciative. At least she seems to be — and it’s great to be appreciated! Some of our patients send us a card around the holidays. I’ve saved every one (and pretty much all the cards I get from every patient, if they have a kind note in them).

The result of the above stellar behavior? I would do virtually anything to try and help her. Back in the late 1990s, when she was very sick with AIDS, one of my ID fellows said it best: “There’s just something about her that makes you want to take care of her.” Exactly.

Based on patients like this, I was drawn to this commentary over in JAMA entitled “Do Nice Patients Receive Better Care?”

It’s a thoughtful piece, with no firm conclusion on the provocative question raised by the title. It’s also a good addition to the whole, “variations in care” theme that has already been extensively studied related to race, sex, patient income, education, and other factors. Here’s the big finish:

Clinicians are human and subject to the influence of bias. Patient behaviors will have a clear influence. It is important to recognize this phenomenon, put it in the proper context, and develop strategies for dealing with it to ensure that professional standards are met. On the other hand, nice patients and patients with nice families probably do receive a level of care that is perhaps at times well above the professional standard. Pretending that this phenomenon is not so is probably not helpful, and raises the next question—is it wrong?

Wrong or not, I can assuredly tell you this: While we may not be able to prove that nice patients get better care, they certainly make being a doctor a whole lot more rewarding. And fun.

And I thank them for that.

4 Responses to “A Thank You to Nice Patients”

  1. SL says:

    I completely agree. I also think that part of my role as a social worker is to help people get what they need, that is, the “better care”. To this end, it may involve teaching them how to be a “nice patient”. Just like everyone wasn’t taught how to answer the phone with a greeting instead of a noise, patient’s don’t always get that “nice does nice”. I might ask a patient who is struggling with their relationship with their MD, “Is this working for you?” Would you be open to me sharing an alternative?” Let’s face it, everyone would like to be seen as a nice person, some folks just have a harder time making it a reality.

  2. R Jafry says:

    I believe that nice patients usually are attended to by nice doctors. I have seen patients who default treatment and being chided by not so nice doctors. Some stop defaulting when they find nice doctors who listen to their problems and explain their medical conditions.

    Not so nice doctors/health staff will not likely to see many nice patients.

  3. BS says:

    I don’t have patients, but I do have clients and while I would swear that the level of attention and care is uniform throughout, it is so much nicer to deal with “nice” clients. Relationships with “nasty” clients can take on the feel of an abusive relationship if you let it, so it’s important to lay down ground rules at the beginning of the relationship. Nice clients definitely get better treatment.

  4. JC says:

    Thank you for this post. I always enjoy the blog entries – either for their wit, or their practical approach to the mysteries of the world of ID – but this one spoke to the heart.

    I used to feel vaguely guilty about just how much I enjoyed seeing my ‘nice’ patients, and felt willing to go the extra mile for them. But as long as everyone gets adequate care, if they’re what keeps me feeling renewed in my practice and willing to continue slogging through 12 hour days – then I say they deserve every extra bit of effort I spend on them.

    In response to JS above, I’d also like to point out that it’s impossible to distill the medical relationship down to just practitioner and patient. We’re both human – and have bad days, our own viewpoints, and personal quirks. It’s not as simple as ‘nice patients usually are attended by nice doctors’. Sometimes the pair just ‘clicks’…..and sometimes it doesn’t…..regardless of who’s being nice.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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