Do Chronic Patients Count as Obnoxious Ones?

In CNN’s Empowered Patient series, correspondent Elizabeth Cohen examines how to stay informed, on top of your health, and in good communication with your doctors. The most recent installment is Are You an Obnoxious Patient? and the inflammatory headline aside, you should really go read it if you want this post to make any sense.

I won’t go into all the finer points since CNN’s hefty comments section is taking care of that just fine. Also, most of the article advocates mutual, respectful communication on both sides of the doctor-patient relationship, and who can argue with that? (Quite a few people, apparently, judging by those comments.) I imagine treating some of the more pushy, rude cyberchondriacs is just as tiresome as having an appointment with one of the more arrogant, unsympathetic doctors that ignore a patient’s input–even if it is well-researched and articulated–simply because of the lack of medical degree.

But I keep coming back to that first bit of advice:

“Don’t demand medications over the phone.”

Demand, no. But request?

That’s still okay, right? To ask?

One of the examples in this section is a patient who gets 3 or so sinus infections a year, recognizes the symptoms, and wants a prescription called in. But since symptoms of serious disease can mimic those of ordinary, less-threatening ones, doctors are reluctant to do this. (See: second example, kidney infection vs. cancer).

I think we need to make an important distinction here. Patients (or parents of patients) with chronic illness sometimes end up in the doctor’s office 3 or more times a month already. You asthma parents with young children know this. Like I did when AG was younger, you’re probably already spending a substantial chunk of money each month on appointments and prescriptions. You probably know the pediatrician and pediatric specialists very well, and they in turn know you, your parenting style, and your child’s symptoms thoroughly.

In fact, because you end up in the office so frequently, I’m sure you and the pediatrician have built up a pretty solid relationship of mutual respect and communication, so you know that sometimes new prescriptions don’t warrant a visit.

AG sees our small community’s most popular pediatrician who will occasionally call in a prescription without seeing her because having asthma means our pediatrician sees the kid all the time, anyway. This doctor knows and recognizes the symptoms of my daughter’s various non-critical asthma-related ailments, and she knows I recognize them, too. She knows the asthma itself is under control and further, she knows I will bring AG in if those little ailments worsen. Most importantly, though, our pediatrician recognizes that I don’t have unlimited time or money, and I already spend plenty of both at her office. In return, I ask rather than demand and I don’t argue or question her wisdom when I do need to bring AG in.

I’m lucky enough not to have a chronic health issue, but I’m betting those of you who do–or those of you with kids who do, like AG–have similar relationships with regular doctors, too. And for chronic patients or parents of chronic patients who stay involved, empowered, and informed, isn’t that how it should be?

10 responses to “Do Chronic Patients Count as Obnoxious Ones?”

  1. Asthmagirl says:

    It’s a timely post.

    I don’t phone my doc, because I never get him and I don’t like trying to explain things to every nurse and pa that answers the phone, because they always interpret what I’m saying and many times respond: “If that’s the case, you should come in”. No, I don’t need to come in, and if I was talking to Doc, he would know I don’t need to come in. He knows if I did need to come in, I’d be on my way, I wouldn’t be on the phone.

    So I email, because I know he sees exactly what I wrote. And most important, I have spent the last 5 years building a relationship with him so that he can provide good care easily. He knows and trusts me to make good decisions and not balk at coming in or taking prednisone when it’s time. This is also the guy that goes out of his way to make sure I’m improving. calls me on my cell the day after appts. to see if I’m improving (not once, consistantly) and the one time he sent me to the hospital, he called me on my cell and told me to hand the cell to the attending so he could request the appropriate tests and treatments.

    Because of our relationship, I can email him and ask his opinion on a change of meds. He may or may not agree. But like you, that relationship is built on respect and caring and therefore, the communication is respectful and civil. I don’t insist on anything, and he rarely does, because he knows I’m compliant with all my meds and my asthma plan.

    I think it would be counter productive to be less than compliant and still expect him to do his best for me.

  2. Amy says:

    Exactly–I think parents (and patients, too, but I can’t really speak from experience there) HAVE to be willing to listen and to make the appointments when necessary, but drs. also HAVE to be understanding of cases where the patient/child is coming in more than a couple times a year.

    This winter hasn’t been bad, but last year? If I had to take the girls in every single time they needed something, I might as well have thrown a few sleeping bags in the lobby, handed over my debit card, and camped out there for the season.

    It’s all about meeting in the middle, and moderation–you ever notice how every discussion we have here comes down to moderation? 🙂

  3. Asthmagirl says:

    I love moderation! It’s one of my favorite things in the whole world.

  4. Nickie says:

    Great post! I have a chronic pain disorder, but the issues can be similar in just dealing with anything chronic. Unfortunately, mine is pretty unstable, and gets worse pretty frequently. Like you, I have a great relationship with my doctors. I can tell them “this isn’t working”, and they listen.

    Anyway, I saw your post on BlogHer and just wanted to come over and say that I loved it!

  5. PreschoolerMom says:

    Right on. Our Pediatrician goes one step better. Since our son flares from nothing to go-to-the-ER in less than 12 hours, our pediatrician has approved our keeping the oral steroids prescription filled & on hand with us. We apply it immediately we feel it’s necessary, and then call or email him for either a follow-up visit or refill later that day.

    I email in for new inhalers, etc all the time, and pick them up after work. Saves the Ped’s office-hours time for more urgent patients, too.

  6. Amy says:

    Hi NIckie, thanks so much for your kind words.

    Hi PreschoolerMom,
    Your ped. sounds excellent, and you brought up a good point about time here. Thanks for stopping by, and please come again.

  7. Brian says:

    As a physician, I’m going to just come out and say that from your post, you don’t sound like an annoying patient / parent-of-patient at all. I’m annoyed by parents who don’t listen, who don’t follow instructions in the care of their children, or who wait too long to bring their children in.

    I don’t mind if people call me and *ask* for a prescription, particularly if it’s about a problem we’ve seen your child for before, and as long as “no” is taken for an answer if I feel I need to see your child first.

    Chronic patients are NOT obnoxious ones just because they’re chronic.

    Just my two cents.

  8. blessedmomof4 says:

    wow,
    you all are so blessed with awesome Dr’s who you have built good relationships with. It gives me hope for when we get out of the military. Not that I havent had good peds/drs in the military (we’ve been in for 20 yrs. and lived in 6 different places) but each time we get someone different. I am a nurse and each time I go in it feels like a fight to get good care for my asthma girl……finally recently after 4 visits to the clinic, I was given an antibiotic for my dd chronic sinus infection that they had said was a normal cold/asthma flare…..I had to practically cry for a referral to the specialist at our Naval facility…….it all was worth it in the end, b/c I ended up (after many phone calls) getting in within a couple days….instead of the 30 days they had told me (she still would not have been seen by a specialist until 30 Jan!) After being persistent (and probably obnoxious :(……I got her an appt. and the PA who specialized in Asthma/sinus issues was AWESOME! I’m glad I was her advocate….and I have learned over the 20 yrs. to try to stay calm, and polite, but never stop asking. Anyway, really LOVED your post and all the great comments…….I am learning to not step down, but also being kind and considerate even if I feel like the dr. I am seeing is not listening and really doesnt take me seriously………great to have places to read and learn how to be a great advocate/ and not be obnoxious (LOL)!

  9. Amy says:

    Hi Brian,
    Thanks so much for giving us the perspective from the doctor’s side. I really appreciate your two cents and especially hearing that the things we suspect we’re doing right–listening, following medical instruction, staying on top of our kids’ health–are, in fact, noticed by you guys, too. Thanks again.

    Blessedmom,
    That’s an issue we haven’t really addressed before–the transition from military to private healthcare. You’ve given me some food for thought today. (check your email later) 🙂

  10. lauren says:

    it’s refreshing to see some intelligent comments on this subject.

    I was a receptionist for a very large medical practice for 5 years and . I was very suprised at some of the comments on cnn.com. Granted, no one likes to wait around for long periods of time for your appointment but people need to understand that no one is quadruple booking a doctor and snickering at the poor fools waiting out there reading magazines! Do patients really think we (the staff) want to stay late and hear people complain about waiting? You will always have last minute emergencies that need to come in, patients who show up on the wrong day, patients who although have a 4pm appointment–waltz in around 1pm so they can be seen sooner, patients who show up without calling and ask for prescriptions, etc etc etc.

    I wish these people could trade shoes with any medical receptionist for just one day. I gurantee their head would spin.

    blessedmomof4– more people should take your approach! I’m always polite to patients and do my best to accomodate their requests but when theyre rude and demanding, it doesnt give you much motivation to go out of your way to help them…