What Makes a Good Patient?

The blind, overweight patient in the wheelchair has terrible pain in her back and burning pain in her legs. She also has advanced arthritis in her knees and end-stage circulatory disease, which have left her with two useless legs that are red, swollen and infected. Now her shoulder has started to hurt. She can't raise her arm to comb her hair. Five or six other things are wrong with her--she tells me about each. Some we can help; most we can't. I tell her as much.

In my office, she listens carefully. I hardly ever have to repeat myself with Doris (not her real name). She asks questions--mostly good ones. She needs lots of tests, various therapies. I ultimately recommend an operation on her shoulder. Sick, weakened by multiple symptoms and with lousy insurance, Doris is--surprise--a really good patient. She communicates efficiently with her doctors and treats us with respect and trust. She has reasonable expectations. I can tell she looks things up, but her knowledge is helpful--never challenging. I've talked about her with other doctors, and we agree on this: when you see Doris' name on your day's list, you know you're going to work hard. But you're usually glad her name is there.

Few patients realize how deeply they can affect their doctors. That is a big secret in medicine--one doctors hate to admit. We think about, talk about, dream about our patients. We went into clinical medicine because we like dealing on a personal, even intimate level with people who have chosen to put their bodies in our hands. Our patients make or break our days.

Take the compliment. Our career choice means we really do think that you--with your aches and pains--are more interesting than trading hot securities, more fun than a courtroom full of lawyers. Massaging the ego is the key to manipulating responsible types like doctors. When we feel your trust, you have us.

The most compelling reasons to be a good patient are selfish ones. You will get more than free drug samples if your doctor is comfortable and communicates easily with you. You'll get more of the mind that you came for, a mind working better because it's relaxed--recalling and associating freely, more receptive to small, even subliminal clues. That means better medical care. But you should try to be a good patient for unselfish reasons too. We worry about you 60 hours a week. We gave up our 20s for you. Why not show us some love? It's not hard.

The medical relationship is intrinsically one-sided. It's about you and your problem. I am going to find out more about you in the next 20 minutes than you will find out about me. Don't fret about that. We don't expect you to ask much about us. Good patients answer questions accurately and completely. They ask questions too.

But many patients talk too much. You might notice that we are writing when we see you--we are creating your chart. We need specific facts but not every fact in your life. Here's a classic exchange:

How long has your shoulder hurt, Beatrice? "Oh, for quite some time now." But for how long? How many months? "Oh, at least since the wedding--well, then again it did act up a bit when Margaret came back from Ireland ..."

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