Are you an obnoxious patient?

[Bent_Bladi]

Are you an obnoxious patient?

ATLANTA, Georgia (CNN) -- A few months ago, Dr. David Golden says, he had to fire a patient for being obnoxious.

The patient had a cough. After examining him, Golden recommended a medication. But then the patient did his own research and became worried about side effects.

"He said, 'But I read about this on the Internet, and I know this and I know that, and I know I'm right,' " remembered Golden, an allergist in Baltimore, Maryland.

Golden says he tried to explain why the side effects weren't as bad as the patient thought, and why the medicine would take care of his cough. "But he wasn't open to discussing anything. He countermanded everything I said. So I told him, 'You know it all, so go take care of yourself. I'm not your doctor anymore.' "

Golden says he's all for empowered and educated patients, but some patients have become so empowered, they're actually putting their care in jeopardy.

"I've been doing this for 28 years, and unquestionably it's gotten much worse," Golden says.

But wait a second. Isn't it good to question your doctor? You don't want to passively accept everything they say, right? Absolutely, say Golden and other physicians. The doctors we interviewed agreed that getting the best care means being empowered but not obnoxious. Here are tips from a few of them, plus some from a patient.

1. Don't demand medications over the phone

Let's say you get sinus infections several times a year. You know what they feel like. The same medicine helps you each and every time. You want your doctor's office to call the prescription in to the pharmacy. Why should you go in and get examined when you know what's wrong with you? Sounds reasonable, right?

This issue rankles doctors like none other. Doctors don't like prescribing medicine without first seeing the patient, period.

"When my staff asks them to come in, they say they're too busy and they know what's wrong with them. It's a very common thing," says Dr. Jeff Hurwitz, an internist in Hagerstown, Maryland. "But health care isn't just saying, 'These are my symptoms. I know what's wrong with me.' Medicine is an art. You need to go see your doctor."

Hurwitz remembers one patient who demanded medicine for a urinary tract infection over the phone; she'd had them before, and she was having one again. Hurwitz insisted she come in to be seen. She insisted she wouldn't. He won, and it's a good thing for her: It turned out her symptoms were caused by kidney cancer, not a urinary tract infection.

2. Don't come in loaded with Internet printouts

Trisha Torrey, the moderator of about.com's Patient Empowerment section, recommends making bullet points after reading information on the Internet. "Don't bother printing copies of your research for [your doctor.] She doesn't have time to read them," she says. (Click here for Torrey's advice about using the Internet for your health care.

Another piece of advice: Be careful how you bring up Internet information. Sounding like you know more than the doctor does could result in alienating your doctor and getting less than optimal care.

Let's say, for example, you've been having horrible headaches. Your doctor thinks it's nothing serious and you just need a good over-the-counter pain medication, but you're worried the pain in your head might be something more serious.

You go online and read all about what a headache could be (a brain tumor, for example), and now you want to talk to your physician. Dr. Delia Chiaramonte, a patient advocate in Baltimore, has these do's and don'ts:

Don't say, '"Please look at these printouts. They say I should have a CT scan to rule out a tumor. You really need to read these -- when doctors don't listen to patients, the patients die."

So what should you say? "Acknowledge the slight discomfort of the situation out loud," advises Chiaramonte. "Say, 'I know doctors may not love patients coming in with Internet printouts. But would you mind looking at these? I'd love to hear your thoughts,'" Chiaramonte says, adding that you should ask your doctor for Web sites he or she recommends.

Dr. Scott Haig, an orthopedist in New York, agrees. He says he doesn't mind when patients come in with Internet information -- it's all about how they ask about it. He says don't make your doctor feel like his back is up against the wall. "Permit for an exchange of ideas," he says. (To read a Time magazine column that Dr. Haig wrote about one of his obnoxious patients, click here .)

3. Arrive organized

Christine Miserandino has learned a thing or two from her frequent doctor's appointments for lupus. Miserandino, who writes about her illness on her Web site, says that before each appointment, she fills out three index cards: one with any new problems she needs to tell her doctor about, one describing her current symptoms, and a third with specific questions for the doctor.

Miserandino says this gets her better care. "My doctor is busy, and I have to respect that he has 40 patients in one day," she says. "If I don't go in with all my questions written down, I'd be rambling all over the place.

4. Need a lot of time? Ask first.

Doctors often schedule appointments in 15-minute increments. Sometimes you'll need much more than that. Miserandino says she always warns the appointment secretary when she'll need extra time, and asks whether a certain time of day (such as the last appointment) would be better.

Chiaramonte also suggests asking whether certain days of the week are bad (perhaps your doctor has several surgeries scheduled on certain days), and says you can also request two appointments back to back.

5. Exercise basic human kindness

Remember, your doctor is a human being, and we all respond better when we're treated well.

"Show human courtesy and respect who they are. I'm talking basic human interaction 101," Haig says.

Miserandino says she doesn't shy away from asking tough questions -- on the contrary, she asks lots of them and sometimes questions her doctor's recommendations -- but she always does it politely. Plus, she fosters a relationship with her doctor because she knows that to a great extent, her health depends on him.

"I do care, because I want him to care about me. I do bring cookies at Christmastime. It's a relationship you have to foster like any other."

Once, when her doctor went above and beyond what he had to do by visiting her in the hospital twice in one day, she wrote him a thank-you note. "He said to me, in the 20-odd years I've been doing this, I've never received a thank-you note. I always hear the negative, never the positive," she says.

[Bent_Bladi]

When you're really sick but your doctor is booked for the next month and you have to get on that darn waiting list...

What to do?

BE AGGRESSIVE!!

When you're talking to the appointment secretary, either on the phone or in person, be aggressive! She or he tells you that the doctor is booked for the next month or so and you need to be put on a waiting list, don't take that! Argue with them --- "Excuse me, but I'm in sever pain and I fear that if I'm not seen by a doctor soon my condition may worsen".

"I'm sorry ma'am (sir), but he's not available this month"

"Well look here and there - see if he has an opening, let me talk to him if possible"

Now either one of two things can happen...

You can get squeezed in one of the doctor's appointment gaps, or the secretary won't find a spot... in that case, keep arguing... Get yourself to be #1 on that waiting list or something.

Don't be like this person:

"Hello, I'd like to make an appointment with Dr. So-and-so. I'm having severe back aches and I'm afraid my condition will worsen with time"

"I'm sorry but Dr. So-and-so is booked for this month, I can put you on the waiting list if you want."

"Sure, thanks a lot"

When it comes to your health, be a monster!!!! But a polite one

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lol, I got this story from my dad -- hee hee, the power of aggression can take you places

[Bent_Bladi]

(To read a Time magazine column that Dr. Haig wrote about one of his obnoxious patients, click here .)

When the Patient is a Googler

We had never met, but as we talked on the phone I knew she was Googling me. The way she drew out her conjunctions, just a little, that was the tip off — stalling for time as new pages loaded. It was barely audible, but the soft click-click of the keyboard in the background confirmed it. Oh, well, it's the information age. Normally, she'd have to go through my staff first, but I gave her an appointment.

Susan was well spoken and in good shape, an attractive woman in her mid-40s. She had brought her three-year-old to my office, but was ignoring the little monster as he ripped up magazines, threw fish crackers and Cheerios, and stomped them into my rug. I tried to ignore him too, which was hard as he dribbled chocolate milk from his sippy cup all over my upholstered chairs. Eventually his screeching made conversation impossible.

"This is not an acceptable form of behavior, not acceptable at all," was Susan's excruciatingly well-enunciated and perfunctory response to Junior's screaming. The toddler's defiant delight signaled that he understood just enough to ignore her back. Meanwhile, Mom launched into me with a barrage of excruciatingly well-informed questions. I soon felt like throwing Cheerios at her too.

Susan had chosen me because she had researched my education, read a paper I had written, determined my university affiliation and knew where I lived. It was a little too much — as if she knew how stinky and snorey I was last Sunday morning. Yes, she was simply researching important aspects of her own health care. Yes, who your surgeon is certainly affects what your surgeon does. But I was unnerved by how she brandished her information, too personal and just too rude on our first meeting.

Every doctor knows patients like this. They're called "brainsuckers." By the time they come in, they've visited many other docs already — somehow unable to stick with any of them. They have many complaints, which rarely translate to hard findings on any objective tests. They talk a lot. I often wonder, while waiting for them to pause, if there are patients like this in poor, war-torn countries where the need for doctors is more dire.

Susan got me thinking about patients. Nurses are my favorites — they know our language and they're used to putting their trust in doctors. And they laugh at my jokes. But engineers, as a class, are possibly the best patients. They're logical and they're accustomed to the concept of consultation — they're interested in how the doctor thinks about their problem. They know how to use experts. If your orthopedist thinks about arthritis, for instance, in terms of friction between roughened joint surfaces, you should try to think about it, generally, in the same way. There is little use coming to him or her for help if you insist your arthritis is due to an imbalance between yin and yang, an interruption of some imaginary force field or a dietary deficiency of molybdenum. There's so much information (as well as misinformation) in medicine — and, yes, a lot of it can be Googled — that one major responsibility of an expert is to know what to ignore.

Susan had neither the trust of a nurse nor the teachability of an engineer. She would ignore no theory of any culture or any quack, regarding her very common brand of knee pain. On and on she went as I retreated further within. I marveled, sitting there silenced by her diatribe. Hers was such a fully orbed and vigorous self-concern that it possessed virtue in its own right. Her complete and utter selfishness was nearly a thing of beauty.

When to punt is not a topic taught in medical school. There is but one observation that I can offer: Patients like Susan, as self-absorbed as they are, know it immediately. They can tell when you're about to punt.

I knew full well what was wrong with this woman, and I could treat her, probably as well as anyone. But treating her condition, which was chronic patellofemoral pain, would test the mettle of patient and surgeon. What we have doesn't work very well nor very quickly. The swelling takes months to go down, the muscles take even longer to strengthen. Good patients often complain, "It was better before we started," in desperation or anger, before they see improvement. But with plenty of therapy, braces, exercises and one or two operations, this knee does improve. It's often tough going, though, and patients have to stick with you. I like to be straight — "It gets worse before it gets better" is what I tell them. Susan's style, her history and, somehow, most telling, the way she treated her son said she was not going to make it through this. Not with me, anyway.

A seasoned doc gets good at sizing up what kind of patient he's got and how to adjust his communicative style accordingly. Some patients are non-compliant Bozos who won't read anything longer than a headline. They don't want to know what's wrong with them, they don't know what medicines they're taking, they don't even seem to care what kind of operation you're planning to do on them. "Just get me better, doc," is all they say.

At the other end of our spectrum are patients like Susan: They're often suspicious and distrustful, their pressured sentences burst with misused, mispronounced words and half-baked ideas. Unfortunately, both types of patients get sick with roughly the same frequency.

I knew Susan was a Googler — queen, perhaps, of all Googlers. But I couldn't dance with this one. I couldn't even get a word in edgewise. So, I cut her off. I punted. I told her there was nothing I could do differently than her last three orthopedists, but I could refer her to another who might be able to help. A certain Dr. Brown, whom I'd known as a resident, had been particularly interested in her type of knee problem.

Disappointed and annoyed, Susan stopped for a beat.

"You mean Larry Brown on Central Avenue?"

"Uh, yes —" I started.

"I have an appointment with him on Friday. And, Dr. Haig?" she said, pulling Junior by the arm out my office door, "Watch out on your drive home tonight. There was an accident near your exit."