"Hateful patients"?

 
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PostPosted: Sat Sep 08, 2012 1:03 pm    Post subject: "Hateful patients"? Reply with quote

Way back in 1978 the New England Journal of Medicine published an article entitled "Managing the Hateful Patient." I happened to notice it because I was working in the medical publications department of a publishing house at the time--and I became angry enough about it to write a letter to the journal, which it published (August 17, 1978; vol. 299, pp. 366-367). Here are some excerpts:

Quote:
If a layperson can presume to have gained a glimmer of understanding of an article in your journal (James E. Groves, MD, "Taking Care of the Hateful Patient," 298: 883-887, 1978), I have to register horror at what I perceive to be its content.

If some doctors are repelled by some of their patients, I question whether they are in the right field. One possible justification for the high fees doctors command has been the importance and the often demanding nature of teir work. Yet it seems that high incomes are not enough to compensate the physician for his tireless service to mankind: now he must divest himself of some of his more "repulsive" or "hateful" patients. If the patients were not managing, collectively, to keep their doctors in considerable style, I might almost believe that the poor physicians were justified in biting the (repulsive!) hands that feed. However, as doctors earn more than most of us, I am inclined to think that they have an obligation, if not to love every embittered soul or every whining denier among us, at least to tolerate us without being repelled.

...

The lawyer described by Dr. Groves had at least "the trappings of real achievement": he was not one of those rejects in the previous paragraph who have earned little and deserve little; no, he was a specialist in medical negligence--capable of making considerable trouble for the physician. So he was taken seriously, whereas others, who were not so fortunate as to be powerful enough to oppose the medical profession, were disregarded when they behaved as if "entitled."

The patient who had had 10 operations in 12 years is classified as a "manipulative help-rejecter" for whom nothing seems to work. I wonder, if the patient's over-riding problem was depression, why 10 operations were done? Were they unnecessary? (Or was the physician disposing of a "hateful" patient by dismantling her part by part?)

Then there is the Solomon Grundy-like case of "Old George" and the statement that self-destructive deniers evoke in their care givers the secret wish that they will "die and get it over with." I realize that to alleviate the pressures of working with the sick, medical personnel understandably resort to their own brand of macabre humor. However, this incident stretches my capacity for understanding. We are all terminally ill, in a sense; then, whether we go out early or late, do we not deserve doctors who do not wish that we would "die and 'get it over with'"?

_________________
MS diagnosed 1980.

Avonex 2002-2005. Copaxone 2007-2010.


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