Here are 10 culprits of the Good Patient Syndrome, where otherwise assertive individuals find themselves strangely mute as patients.
1. Pain is often invisible.
“Someone with diabetes may be viewed in the context of how they comply with instructions, but the professional will believe their medical story and complaints,” explains Bonnie Cardenas, PT, director of Cardenas Physical Therapy. “To the contrary, someone with chronic pain, for which there is no obvious etiology, will be viewed very differently…The patient’s veracity and emotional state may be suspect.”
2. Pain patients are often stigmatized.
“So many pain patients are listed as ‘head cases,’ ‘train wrecks,’ ‘drug seekers,’ and ‘psych cases’ before they are ever even seen,” reveals Shannon Stocker, M.D., who herself suffers from Complex Regional Pain Syndrome. “Especially with regard to women in chronic pain, unless they are exhibiting physiological symptoms that can be measured and proven, ‘pain’ is equated too often with ‘psychosomatic.’ It makes the ability to achieve a mutually-respectful relationship nearly impossible. And if a physician does not believe or trust a patient, effective treatment is obviously not going be given, and the patient will continue to suffer.”
3. The response to pain medication is often misunderstood.
Opioid medications may lead to tolerance, dependence, and heightened pain, says Beth Darnell, PhD — Assistant Professor in the Department of Anesthesiology & Perioperative Medicine at Oregon Health & Science University. “While these are medical consequences from prescribed medication, they are also the same consequences one experiences as a result of medication misuse,” she says. “The iatrogenic effects from opioids may be difficult for the provider to tease apart from misuse behaviors, and this can lead to strained patient-provider relations.”
4. Pain patients may have trouble functioning properly.
“My command of the English language is normally strong,” says Bridgette Donahue, a chronic pain patient and former news reporter in Michigan, “however, pain chips away at my ability to communicate.”
5. Managed care does not allow adequate time for complex cases.
Given the current sickness of our healthcare, says David Simon, MD – CEO, medical director, and co-founder of the Chopra Center for Wellbeing, doctors try to fit patients into the system, instead of fitting the system around patients. In addition, he continues, “Most modern physicians are facing time pressure. If they don’t see a certain number of patients in an hour and bill a certain number of visits, then they cannot make ends meet. So any time there is someone who is more challenging for the typical physician practice, that person gets categorized as a difficult patient.”
6. Difficult pain cases are confused with difficult patients.
“Certainly, some people are unwilling to follow recommendations and may over-rely on medication to treat their pain,” says Darnell. “However, some people may try many things in an effort to help themselves and simply not be successful in gaining relief.” Whether from a sense of helplessness or ego bruising, experts muse, providers nonetheless may blame patients for the failure of treatment.
7. Cultural symbols enforce deference to doctors.
The power difference between doctor and patient (white coat, sterile office, one person lying down and one hovering over, one being called “Dr. So-and-So,” the other being called by a first name) “can be formidable,” says Darnell. The patient is “in a subordinate, almost inferior role,” agrees Stocker, making otherwise assertive individuals act deferential around doctors. “The sad thing is that society has fed into this dynamic,” she says.
8. Chronically ill patients have disease fatigue.
Given the exhaustion involved in living with chronic illness and responding to its devastating effect on one’s life, it can be overwhelming to even think about negotiating with a current doctor or starting over with a new one. “People are sick and tired of being sick and tired,” empathizes James Dillard, M.D., D.C., C.Ac – a chronic pain specialist and author of The Chronic Pain Solution. “They just want a break.”
9. Doctors follow in each other’s footsteps.
Every time a patient sees a new doctor, that doctor will request charts from previous practitioners. “Once a practitioner reads or hears that someone is a ‘difficult patient,’ I believe the practitioner inevitably cannot wait for the appointment to be over,” says Stocker. “The practitioner does not believe a word that comes out of the patient’s mouth, so the practitioner does not listen. The practitioner also does not believe that the patient will listen, so the practitioner does not want to invest time and energy into the patient. The patient typically does not listen, because the s/he does not feel heard by the practitioner. And so the cycle continues, with the patient’s well-being getting lost somewhere along the way.”
10. The devil we know seems better than the devil we don’t.
“A lot of people don’t understand what it’s like to be taken care of by a good doctor who really is there for patients,” says Dillard. “They stick with a miserable status quo, because they just don’t know any better…Why do women stay in abusive relationships and bad marriages? They feel powerless. They feel like they don’t have any other options. It’s the same psychology. It’s the Stockholm Syndrome.”