David Buck, M.D., M.P.H., has agreed to share his own experiences with complex patients. This specific story highlights the importance of doctor-patient interaction when caring for complex patients. Welcome to our newest segment:
Provider Stories: Patient-Provider Power Struggle
I once worked with a patient (let’s call him Mr Knecht*) that struggled with mental health disorders, but refused to take the prescription medicine he was given. Mr Knecht could be difficult. He would overwhelm all the doctors and nurses who worked with him. He would throw us out of the room while we were trying to treat or evaluate him.
At some point, he agreed to start taking medications, eating healthier, and visiting his primary care provider. Eventually, he requested a specific medication during one of his many admissions, but it was expensive –too expensive for the psychiatrist working with us to agree prescribing it. He was offered a cheaper medication that had more unfavorable side effects, but refused it and left the hospital.
When he returned, the psychiatrist offered the requested medication under the condition that he take it immediately—a condition the patient refused to accept. The psychiatrist discharged him from the hospital. He was arrested in the parking lot and taken to jail. Within 24 hours of his release he was admitted into another hospital.
Stories like these are not shared to display sympathy towards complex patients, or sympathy towards providers with difficult patients. They are shared so that we as a community can identify gaps in health care and provide solutions for better health outcomes. This was a clear power struggle between patient and provider. If the provider would have communicated with the patient (no matter how difficult the task might have been), they could have come to an agreement, saved millions of dollars, and saved the patient a trip to jail –a circumstance that was likely to have set back the patient’s health progress.
From this story, PCIC learned there is a need for clear communication between health systems as a tool for providers to best treat patients who are admitted into multiple systems. It is likely that this patient started practicing health-affirming behaviors as a result of visiting his primary care provider or another health system provider who listened and included the patient’s goals into the care plan. If this care plan had the ability to be shared and updated across all systems, the psychiatrist might have been able to facilitate a different outcome.
We have also learned there needs to be much more to a doctor-patient relationship than technical transactions and provider-managed care. There needs to be basic respect towards human beings (regardless of how articulate or unintelligible a patient may be), and there needs to be interaction and a willing attitude from both parties.
* Patient name and diagnoses have been altered to respect confidentiality.
