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Lauredhel is an Australian woman and mother with a disability. She blogs about disability and accessibility, social and reproductive justice, gender, freedom from violence, the uses and misuses of language, medical science, otters, gardening, and cooking.

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24 responses to “AMA delegation seeks to code for non-compliant and ungrateful patients”

  1. Mindy

    Doctors really need to start understanding that they are not God. A story from my Mum, about a local Dr who had a ‘reputation’ for being difficult (and is in fact the reason that I only ever go to the doctor when I’m really, really undeniably sick or needing a shot of something): a woman she knew was having problems with her blood pressure. Rubbish said the doctor, you are fine. No, she insisted, something is wrong, I want to be referred to a specialist. Dr grumped and grizzled but finally wrote her a referral and put it in a sealed envelope (don’t you hate it when they do that, as if you aren’t allowed to have access to your own health information). An appointment was made with the specialist. Then she opened the letter. The Dr had written, after the usual ‘please see blah blah etc’ “This woman has strange ideas about her own health”. She was not happy.

    So she gets to the specialist, and hands over the letter. When the specialist finishes reading it, she tells him that she has read it too. Then she tells him why the Dr is wrong and what she thinks is wrong with her. She then asks the specialist to treat her as he would any other patient who was referred to him. Which to his credit he does. Tests are done, her blood pressure is too high and in need of medical intervention. The specialist treats her, and her health improves. She changes her Doctor and encourages everyone else she knows to do the same. Unfortunately in a small country town, not everyone has the option of changing doctors. But a lot of them did.

  2. tigtog

    *boggling*

  3. Mindy

    Every time you don’t understand what your Dr is talking about because English isn’t your first language

    Every time your Dr has had a bad day and decides to take it out on you for trying to be informed about your own health

  4. huckle

    It was all bad, but the ‘stress of dealing with ungrateful patients’ has to be the worst of it. There is this peculiar entitlement about medicine- accountants don’t complain righteously about ‘ungrateful clients’, electricians don’t complain about ‘ungrateful customers’. Doctors, like everyone else, are paid to do a job. They provide a very important and sometimes life saving service and they are well paid for doing so. Their sense that everyone has to fall to their knees in gratitude on top of this is tedious.

  5. WildlyParenthetical

    Every time your doctor assumes to know your situation better than you do. Sometimes, even when you diagnose someone as depressed, they can know that they’re safe enough to wait until they can see the counsellor they just wanted a referral for. It’s entirely possible. And in fact, attempting to scare them into compliance by warning that ‘depression can be fatal’ is also fucking uncool (it’s lucky I am already pretty cynical and critical of what goes on in a doc’s rooms, though I’m a little sad I wasn’t together enough to make a complaint about that guy). Or alternatively, someone can need the morning after pill because they’re playing it safe, precisely because they’re not the reckless idiots you’re treating them as, and without actually needing to immediately go on the pill as a result.

    With respect to the report, I found “labeling patients and acknowledged a desire to be sensitive to the possible mental health issues of non-compliant patients” quite problematic: non-compliance just became an indicator of mental health issues. That’s right, because there are no reasons for refusing to comply with your doctor’s wishes… only crazy people do that. I can’t believe how swiftly the medical profession will pathologise anything it doesn’t like.

    And I think huckle’s right, the ‘stress’ claim is especially problematic: it indicates that physician job satisfaction is bound to having others do as they are told. I get that it would be hard to watch someone do something you think is unwise, truly, but that’s the freaking job! That’s a problem involved in most jobs, and people learn to deal! In the end, I think this points out that some serious revamping of medical education is required, namely in circumscribing what, precisely, it is that doctors think they’re doing for the bodies sorry, embodied individuals they can (only sometimes and only ever partially) help. But phew, the sense of entitlement….

  6. Liam

    Whereas, Any complaint to any oversight investigative regulatory body leads to uncompensated expenditure of time, resources, and monies to defend physicians or the “guilty until proven innocent” principal

    Heh. I’m going to try this line out next time a cityrail inspector asks to see my ticket on the train.

  7. Jennifer

    This stuff makes me quite uncomfortable, because I work in an industry that does talk about non-compliant patients. Whilst not medical insurance, it’s worker’s compensation insurance, and the compliance measures are actually set out in law (as are most aspects of W/Comp in Australia), and we have provisions to suspend wages benefits (though not treatment) due to non-compliance. I know our company, as policy, will generally, y’know, talk to people about why they don’t want a certain type of treatment, and, contrary to popular opinion about insurance folk, I’ve argued with doctors on an injured person’s behalf because doctor is being an ass, but I know other companies aren’t so much, and I really shudder to think what they do to people. (Don’t even get me started on the fact that I, with my complete lack of medical training, have statutory power to decide whether medical treatment is “reasonable”, whatever the hell that means. That’s a rant for another day).

    I think other people have distilled the God complex and entitlement and “being disobeyed = stress” scariness quite well, but, y’know, this whole idea of compliance skeeves me out generally, because even though I have issues with how it can be applied in my line of work, ultimately if I’m not paying the bills, those people still have access to medical care under the Australian system. The idea of similar compliance measures being applied to health insurance in a country where it’s basically a requirement for general health care skeeves me the fuck out.

  8. Liam

    I think you should spell “principal” like that, too.

    Myairs. Is it because the presumption of innocence should come first—or just these physicians concerned with [sic]ness?

  9. SunlessNick

    Holy crap.

    And holy crap on this too – This is a country that sent law enforcement officers into a woman’s home, bound her legs together, and forcibly operated on her in the name of fetal rights. – which I hadn’t seen before.

    Ugh.

  10. Ariane

    The fact that doctors think all this is mind boggling enough. The fact that they have no compunction in stating it publicly is beyond belief.

    I have been non-compliant for a huge range of reasons, and only rarely because of bad doctoring. The assumption that non-compliance actually reflects badly on the doctor is also flawed.

    And yes, I was a touch horrified by the non-compliance=mental illness implication. I am clearly in need of psychological help immediately, given the number of scripts I haven’t filled, tests I haven’t done – even surgery I refused. Sheesh.

    Ariane’s last blog post..Feminism 101 – for a 6 yr old

  11. DeusExMacintosh

    These guys need to make up their mind. They desperately fight to preserve private medicine and support their bloated fees, then get jacked off when patients don’t grovel gratefully. Guys, your patients don’t own you THEY RENT YOU, and as such are expecting decent service. The price of preserving your “I’ve got the time if you’ve got the dime” medical system is growing a new pair and recognising that you’re just another service supplier.

    And if black-listing is illegal when insurance companies do it, what makes them think it wont be for doctors?

  12. shadesofblue

    Who could this affect? If you’re currently saying “piffle, that will only apply to methed-up assholes who physically threaten the staff”, think again.

    This.
    I am a 29 year old, middle class professional. I also have Bipolar I. I have been actively non-compliant during manic episodes, usually because I would not allow them to draw blood (oh gee, Im already paranoid and agitated and some stranger is coming at me with a syringe when I have TOLD them about my debilitating phobia of needles. Nice one).

    Under this legislation, I would have been identified as both hostile AND non-compliant. Bye bye insurance. Bye bye being able to afford my meds. Hello to more ‘non-compliance’ and ‘hostility’.

    This is just appalling. I understand the need to ensure doctors and nurses have a safe work environment, but perhaps if better training was given around identifying reasons for non-compliance and ways of addressing these issues (such as better mental health training) then some of these situations could be resolved without becoming a problem in the first place.

  13. amandaw

    So when I had that abusive doctor start yelling at me about addiction 20 seconds into the appointment, and say I needed to be sent into rehab, and I walked out on her, what punishment would I have faced? —
    what about when you consider my regular GP read my subsequent letter, and was very obviously displeased with the first doctor and the only words he would give me about it were “Hurt people hurt people”?

    Sometimes EVEN DOCTORS DISAGREE; one doctor saying something about a patient does not make it The Law Of The Land.

  14. amandaw

    I mean, I can’t count the number of times I’ve had doctors *within the same practice* disagree on diagnosis, treatment course, etc. for me. Much less just different doctors altogether. One doctor thought there was no way I had asthma; five other separate doctors have diagnosed it five separate times (before and after him). OTOH, when I was going through that year before being diagnosed with fibromyalgia, my regular doctor tried to diagnose it as mononucleosis and then an STD. (I was twelve.) despite no evidence in his favor, just casting about for *something* to explain what was obviously very wrong with me.

    It just makes no sense that because the patient disagrees with the diagnosis, will not follow treatment as prescribed, or was less than docile speaking with the doctor, there should be huge consequences for that. And that’s even without considering the patient’s own bodily autonomy ‘n all that silly stuff. Even OTHER DOCTORS might be telling the patient to do (whatever it is). What then?

  15. annaham.livejournal.com/

    My D: face is on, and I have a feeling that it will stay for a very long time.

    Way to go, AMA.

  16. Jill--Unnecesarean

    Thanks for the link. These are great comments. I was about to reply to WildlyParenthetical’s concern about the sensitivity to mental illness line (that was the one phrase that jumped off the screen at me), but got totally sidetracked by laughing at Liam’s [sic]ness comment.

    Coding for abusiveness and hostility (as behaviors, not attitudes or personality judgments) wouldn’t always be a negative. With relatives that are psych techs and ER nurses, I understand how it might be nice to know if patients have physically attacked others in the hospital before and if they might be going home again with a black eye after a take-down. A few doctors pointed out to me that it is helpful for documentation to be able to note if a patient turned down a recommended treatment (vax, abx, etc.).

    I’ve read so many doctors write about how they are opposed to online ratings of doctors because they’re unscientific or pseudoscientific. I don’t understand what they expect… an RCT conducted to measure someone’s awesome or crappy bedside manner? I think they just don’t want to have people complaining about them openly. And really, who does? What really got me with this resolution was the use of words like arrogance, non-compliance (in the failure to obey sense), ungrateful, stress that leads to illness, physician satisfaction… and on and on. how much more subjective can it get?

    Jill–Unnecesarean’s last blog post..AMA Resolution 710 to Identify Non-Compliant Patients Not Adopted

  17. Linda Radfem

    “people who they think hold “the belief that they own their physicians”

    Anyone who has ever worked in any kind of service industry has experienced clients/customers who are of the belief that they own you for the time that you are taking care of them, even if it’s only for a few minutes.

    I wonder what’s got doctors heads even further up their arses than they already were; is it because of the resources running out, the economy fucking up and things like basic medical care turning into luxuries, that they’re getting so cocky?

    Linda Radfem’s last blog post..My War On The Chaser

  18. WildlyParenthetical

    @Jill Oh yeah, for sure, I can see the usefulness of keeping a history, especially in terms of providing support both for workers and patients. But the explicit phrasing characterises non-compliance as potentially indicative of mental illness, and that, I think, remains extremely problematic. I’m getting a bit over this tendency to see ‘stuff wot we don’t like’ as a sign of pathology simply because those who don’t like it have the capacity to deem it so (I’m thinking of the updating of the DSM as bringing out some other examples of this tendency: http://aebrain.blogspot.com/2009/05/youve-got-to-be-crazy-baby.html.)

  19. Jill--Unnecesarean

    WP, that was exactly the red flag that waved itself wildly at me when I read the report. Looking at how this resolution or mentality would affect maternity care and women’s health made me concerned about bringing a phony concern for “possible mental health issues of non-compliant patients” into the picture. For some medical professionals, women are considered out of their minds to refuse drugs, anesthesia or c-sections already. Labor is HYSTERICAL and competence is questioned when you’re pregnant. Plus, you’re right… if you don’t comply, you’re clearly crazy, right?

    Jill–Unnecesarean’s last blog post..Watch It, Sister! Your Words Might Get a Little Twisted

  20. icca

    You know what my favorite experience in the past year was?

    It was getting a letter from my psychiatrist that he would no longer treat me because I was, basically, non-compliant. Except that the reason for it was because I was seriously ill and my meds were not the right meds for me, and I was in a crisis stage.

    If his decision that I was just wasting his time (and causing him undue stress?) followed me, I don’t care to think where I could be right now.

  21. WildlyParenthetical

    Such an awful vulnerability, icca, I’m sorry. I hope you’re getting the support you need now. Let’s just hope this kind of thing never becomes standard practice. I have to say, they could have been a *teensy* bit more emphatic with the ‘No’.

  22. LookADiversion

    And people wonder why I hate doctors. I already have had enough of them talk to me like I was five years old for no apparent reason, assume any physical problems are imaginary since I have mental health issues, threaten me, automatically assume I’m lying, behave as though I am intentionally doing something wrong or just trying to be difficult when prescribed medication makes things worse, tell me being more active would solve everything despite that most of the problems started back when I was considerably more active, insult me to my face… Hell, lots of temporarily-able-bodied mentally “normal” people I’ve known have had horror stories about doctors who ignored serious problems because they wanted to insist it was just them being whiny/crazy/manipulative, or who otherwise behaved nastily just for the sake of the power trip. (Oddly enough, it’s more often women I hear these from when the “WTF is wrong with these doctors” conversation comes up, though. Gee, I wonder how that happens…) Friends/relatives/acquaintances who are have disabilities or are or mentally ill or so on just about always have a much longer list of these incidents.
    Just fucking lovely that they want more power to punish suffering people who are so badly behaved as to not worship them as gods. As if they don’t already do enough damage with the power they have. And no, I don’t feel especially reassured there.

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