Discounting Patients Creates a Lose-Lose

This is one of those post ideas that just lands in my lap and begs to be written.

I attended a presentation this week, and the woman sitting next to me began her tale of healthcare frustration — just as almost anyone who has sat next to me at a presentation, and learns what I do for a living, has done for the past few years.

Her story was about her dad, and his interaction — or lack thereof — with his doctors. Bottom line, he went to an appointment, his doctor dictated next steps, and then when her dad got home, he got upset and frustrated that he didn’t understand what he was being told, and he didn’t like the way the doctor spoke about him — like he wasn’t in the room.

I call that discounting — the idea that the person being talked about is treated as if s/he isn’t there. Or when the person raises an issue, needs clarification, or wants to complain, they are dismissed at hand, as if whatever they are talking about is fantasy.

Then this morning I received an email from an older woman who I’ll call Madelyn, who was humiliated during a breast cancer examination. She was not given anything to cover herself, and was then examined by a group of interns. She was frustrated and embarrassed, and when she complained about it, she was told it didn’t happen.

Discounting at its finest.

I even observed it myself when my mother in law was in the hospital last winter. The professionals would talk to my sister in law as if Mom wasn’t in the room, asking for decisions as if Mom wasn’t a part of them. It made the hair on the back of my neck stand up.

Discounting — as if the patient was invisible!

These scenarios are repeated, in various iterations, everyday. And, I have no studies to back this up, but my guess is that certain segments of society suffer discounting more than others, e.g. the elderly, women, people of certain cultural or racial backgrounds, people who can’t read, and certainly children (although that is likely a function of who the parent is.)

And the problem is, there is absolutely NOTHING gained by any party when it takes place.

Patients LOSE: because they feel belittled, they don’t understand, and ultimately, they won’t comply with instructions because they don’t understand them — and — because they don’t feel important enough to comply either. Way too often, their health doesn’t improve either.

Doctors LOSE: because when a patient feels discounted, s/he will be angry, and will share that anger with loved ones and friends — and use the doctor’s name or the practice name. Further, when the patient doesn’t comply, because the patient doesn’t understand, then the patient will get sicker — and go to see another doctor (at least I hope that’s the case! I do know Madelyn did — and cheers to her for doing so.)

Why does it happen? Blame lands in both camps. Doctors may be arrogant, condescending, or sometimes they are just in a hurry! Patients don’t command the respect they deserve — they behave as if they should be discounted, and then they are.

Eliminating the practice of discounting is the responsibility of both parties, IMHO (in my humble opinion! OK, not so humble maybe…)

We patients must stand up for ourselves. No matter what age or gender or cultural background, patients need to tell the doctor when they don’t understand and need to ask for further explanation. If a patient feels discounted, s/he needs to point it out! The key is to make sure the professional understands that they are doing the discounting. “Doctor, please don’t talk about me as if I’m not in the room.” Or “Doctor, I need to understand this or I won’t be able to comply with your instructions.” Try not to get rude, I suppose — but be very clear about how you feel, and what you want him to do instead.

And patients — another piece of advice. From the moment you walk into the exam room, don’t behave as if you should be discounted. Patients who ramble, patients who don’t know the answers to their doctor’s questions, patients who behave as if they aren’t responsible or participative — they are the patients who invite discounting. Examine how you communicate with your doctor and step up to the plate with confidence!

Madelyn needed to put a stop to her scenario and insist she be covered and insist the interns leave the room. My friend’s father would have been wise to have an advocate in the room with him. For patients who don’t find relief from discounting, the answer will be — find another doctor.

Doctors — if you are a “discounter,” then you need patients to bring you up short on this. Most of you don’t even know you are doing it — it’s part of the wall you’ve put up all these years. Not all doctors discount, in fact, I’m quite sure most don’t. But I ask you to examine how you treat your patients and make sure you are not only inclusive of them in any conversation, but that you actively ask them to repeat your instructions back to you so you know they understand and are comfortable that YOU are interested in the outcome, and in them.

Frustratingly, I’m sure, the very doctors who need THAT advice never read or heed anything like this anyway. In fact, they discount it. Point made.

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