“No offense to you, Doc, but I hate coming to the doctor.” I hear these words at least once a week when I walk into a patient’s room. In 15 years of practice, that means about a thousand times. And that does not include my training years. There will be variations of the theme, of course: “I really don’t like coming to the doctor.” I get anxious in the doctor’s office. That is why my blood pressure is high.” “Doctors and dentists are not my thing,” and many more. This sentiment is common among all ages, genders, and socioeconomic statuses. The 67-year-old man new to Medicare and has not seen a doctor in 30 years. The 25-year-old woman struggling with anxiety who has not been seen by a physician since a well-child exam ten years ago. The 50-year-old woman with menopausal symptoms who has not seen a doctor since her last pregnancy 15 years ago. The IT professional who came in only because his insurance will give him a discount if he had a wellness exam. It is almost impossible to predict who will utter those dreaded words and to be prepared. I have worked in almost every setting of primary care: urban clinic, urgent care, rural community medicine clinic, Medicaid pediatric clinic, and private practice. It is the same in every single practice. I’m not kidding. It usually starts off as a slightly defensive explanation as to why medical care, especially preventive care, has not happened for years. Most of them are very pleasant and invested in their health. They want to be healthy and prevent diseases. They want to live healthy, productive lives for a long time. They do not want to get sick. They try to eat healthily and get some exercise. Some have relatives who are doctors and nurses. Some of them are doctors and nurses! They genuinely mean no disrespect. But they all hate coming to the doctor’s office. But why? I have pondered this a lot over the years. I used to take it personally. I used to bristle, countertransference would kick in, and I struggled with my thought of:” I am not enjoying this either!” and even the childish “I don’t like you either!” I would get judgmental about myself and the patient. Questions would swarm through my mind: Why do they not like me? Was I not clear? Was I not professional? Was I not approachable enough? Did I not give them enough time? Was there not an opportunity to connect? What could I have done differently? What could I have done better? Why do I have to convince someone who doesn’t like me to care about their health? It seemed like a defeat to me. I wanted to be liked, and I wanted patients to return; I wanted to be a family doctor. Over the years, though, I have figured out some of the answers. Let’s look at it from the patient perspective. It is not about hate or dislikes or even like. It is not about me or any other doctor. It is just that people like places that make them feel good — as in respected, heard, empowered, and comfortable. And the truth is that the doctor’s office is an uncomfortable place. It is where one answers the most intimate questions and speaks their most intimate fears — where they have to face the reality of the consequences of their behaviors and misjudgments. It’s where they are in a vulnerable space, and the person with the white coat holds authority and agency over them. And pain and discomfort are involved. This pain starts with the fear of injections as a child. The doctor’s office is a place where they spend money to be uncomfortable, and one’s own biases are projected on the physician. Where all the denial they have carried for years will be brought to light. Where they might break down in front of a stranger and let the walls around them crumble, and there is always the risk of such vulnerability being ignored or dismissed. It’s a place of blood and pain, tears, and intimate examination. No wonder they don’t like it. No wonder they use the word “hate.” No wonder they don’t come to the doctor unless absolutely necessary. All of us have felt a semblance of this when our family members or we are patients ourselves. We manage slightly better since we know how it is on the other side. Past that discomfort, though, is a place of healing and relief. A place of taking charge, facing the fear, unloading, and making a plan — a partnership. A partnership where the patient comes out on the other side feeling better. So why are we talking about this discomfort of patients in a space for physicians? We have to for the following reasons: This discomfort ends up costing the whole health care system. We have to recognize it in order to put in that proverbial stitch in time to save nine, even when we are not liked. Whatever our qualms about it, our patients look at online reviews while choosing their doctors. Patients who have positive experiences past their discomfort review favorably. Quality performance measures and patient feedback and reviews influence our compensation. The organic growth of one’s practice is and has always been through word of mouth. When patients feel” seen and heard,” that acknowledgment spreads to others. The information overload and social media influence of the times have brought on the need for a more open and collaborative physician-patient relationship. Lastly, we have to do it for ourselves. To uphold the oath we took — to know that if our positions were flipped, we would be uncomfortable just the same and would want someone who listened. We owe it to ourselves to try and bridge the moat. Maya Angelou said, “People will never forget how you made them feel.” So let us: Acknowledge the patient’s vulnerability. Accept it, make it normal. Know it’s not about us. Help and heal. Make them feel better. Source
