3 Times It's Good to Be a "Bad" Patient

Several years ago, I had a pregnant patient who did not seem to grasp the significance of her illnesses (uncontrolled hypertension and diabetes). What she did understand is when she didn't approve of her care. She complained about everything from our nursing staff to how our fluorescent lighting "made her blood pressure go up." She was That Patient.

Some months later, my child underwent a small biopsy to investigate an uncomfortable skin problem. Three weeks went by, and I found myself with a still-miserable kid and no results. I called the office multiple times, but "the doctor was out" and could never be reached. One day, I wasn't having it anymore; I asked to speak to the office manager. Those records? Are my property. You? Will fax them over immediately. And I? Will need to speak to your supervisor if this does not happen today.

The doctor called me two hours later with the results and an apology. I realized: I was That Patient. And you know what? It felt good.

The question is, can you be the super-empowered patient who fixes the problem—without being the rude one who makes the situation worse? The answer is yes. Here's the right way to act up to get the best possible care.

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Nobody is returning my phone calls!
I once had a patient call to report her symptoms of an impending herpes outbreak; she legitimately wanted to be seen and start her antiviral medication right now. But she called Friday afternoon after my office hours. When she spoke to the secretary, she didn't say what she needed—just that she wanted to talk to the doctor. I didn't work at that office on Mondays, so the first I knew about it was Tuesday morning, when I came in to eight angry messages and a livid patient in my waiting room. She was right to be upset and push—but she didn't know the best way to do it.

Part of being proactive is knowing how your doctor's office works. What—and who—are between you and what you need, and how can you get through? Most offices must have someone to cover when their primary provider is not available. So get specific: You need someone who can write a prescription or see you today. Be prepared to give the front desk staff some details about your situation. Once they know that you have a medically urgent problem, they can be your greatest ally in getting a provider to help you.

It's also smart to investigate ahead of time what options your office has—an affiliated clinic? A nurse practitioner who can assess your need today? An electronic portal that can be used to contact your doctor? That way, you're ready to go to the backup plan if you have to.

In my patient's case, instead of leaving increasingly angry messages with a secretary, I wish she had known to utter the magic words "Is there another provider I could speak to?" (I also wish my clinic had had a culture that encouraged the secretary to let patients through more easily; that's something we worked on as a result.)

I've been in this waiting room so long that I'm getting mail here!
Endless wait times make me madder than almost anything else—even as I cause plenty of them. Although my goal as a physician is to see a patient within 15 minutes of the appointment time, that doesn't always happen. Thirty minutes is reasonable for most practices. If you haven't been called in by then, check with the folks at the front desk. Remember: They're probably having a crappy day, too, so demand attention firmly but constructively: "Unfortunately, I can't wait much longer, and I need to decide whether to reschedule. Can you give me an estimated time for when I will be seen?"

There are emergencies and snafus that put even the best-run office out of whack. But if you know where things are heading, you can decide if waiting longer is worth it to you. And if the answer you get is that this is "just how they always run," well, that's important to know, too. For me, that kind of attitude toward my time is a deal breaker. An office that always runs drastically late can be an honest threat to our health, because if doctor's visits take the whole day, most of us are much less likely to seek care when we need it.

Even better is knowing how to avoid delays in the first place. Try to snag the first appointment in the morning (when the doctor isn't yet running behind). There's usually a break between the morning and afternoon sessions, so nabbing the first slot in the afternoon might also help (since, by then, she's hopefully all caught up).

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I didn't get a call about my test results!
When you don't hear about your lab results for a week, does that mean everything is fine? Or did they forget you? Sometimes the lab is still cooking. Depending on the test, it can take anywhere from a few days to a few weeks for the results to come back.

That said, I know that any amount of time feels like forever when it comes to your health (or your child's!). So every time you get a test, ask when and how you'll receive a result. Unfortunately, many offices only call to tell you about "concerning" results. Even (or especially) if this is their policy, it's wise to push: Find out when you can call to hear the boring good news.

This is important because no news sometimes means that no one has looked at the lab report—and that can be dangerous. It may lead to delayed treatment or a missed diagnosis, neither of which is ever OK.

In the case of my kid's biopsy, when the doctor apologized and explained that she had put off telling me the result because she wanted to call me herself, I was mollified. For what it's worth, I've never had to throw a fit at that practice again.

How to get what you want (nicely!)

DO: Try to call for appointments or to ask clinical questions long before the end of business hours; morning is often best so the staff has a chance to grab the doctor before she gets behind or needs to leave.

DO: Politely ask for a call back from someone higher up on the ladder if you're not getting what you need. For medical issues, you might ask for a nurse or a doctor; for procedural stuff (appointments or forms you need filled out), you'll want a nursing supervisor or office manager.

DO: Be aware that the provider you love—the doctor or midwife or nurse practitioner—may have no idea how difficult it is to reach her. Let her know (gently) so she can assess and try to adjust how her staff works. These days, many practices are owned by a hospital, which employs the physician, and so the doctor may not have as much power to change things quickly (the way she would if she ran a private practice). But talking to your doctor can at least start moving your complaint up the chain of command. If she's defensive, or if the office can't seem to get a handle on the problem, you may want to move on.

DON'T: Start out sounding angry (even if you are). Obvious but always worth repeating: Acting as if people are doing their best is a lot more effective in rallying them to your cause than yelling or being condescending. Open with a smile and, if you can, some sympathy—that's more likely to score you that secretly available appointment with the nice doctor and the gowns that close all the way.

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Chavi Eve Karkowsky, MD, is an assistant professor in the Division of Maternal-Fetal Medicine and Department of Obstetrics & Gynecology and Women's Health Services at Montefiore Medical Center and Albert Einstein College of Medicine in New York City.



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