The Patient Trap: Why Assertive Individuals May Act Strangely Deferentially Around Doctors

By: Loolwa Khazzoom, Founder, Dancing with Pain

April 25th, 2010 • Patient AdvocacyPrint Print

From a young age, we are conditioned to follow doctor’s orders, the same way that we are socialized to obey police, teachers, and others in positions of power. “Our conditioning has taught us that doctors are the ultimate authority figure,” says David Simon, MD – CEO, medical director, and co-founder of the Chopra Center for Wellbeing.

This conditioning, Simon continues, begins when we are children. We constantly look to our parents for information, boundary-setting, and nurturing. But when our parents take us to a doctor, they surrender their authority to that of the doctor. “So the conditioning runs very deep,” Simon notes.

“As a physician,” he continues, ”I see people who are leading politicians, major captains of industry, and entertainers, who in almost every other context of their life have the impression that they are in control. But when they come to a doctor, they regress to a very kind of innocent, open mindset where they want to please the doctor. There’s a belief that if they surrender to the doctor, the doctor will help relieve them of their pain.”

I see this happen in the office all the time,” concurs pain specialist James Dillard, M.D., D.C., C.Ac – author of The Chronic Pain Solution. “I see people who are highly accomplished adults, who run large areas of their lives very professionally, get into my office and suddenly turn into four year olds…You see it in any illness where the patients are scared and are relying on the doctors to cure them or save their lives.”

This deferential conditioning not only is initiated when we are young but is reinforced in our adult interactions. A doctor’s opinion about a patient’s symptoms, for example, is given more credence by legal authorities, health insurance representatives, and so on than a patient’s own opinion about them.

What’s more, cultural symbols of the medical office — 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 – feed into the power imbalance in a way that “can be formidable,” says Beth Darnell, PhD — Assistant Professor in the Department of Anesthesiology & Perioperative Medicine at Oregon Health & Science University.  

The patient is in a “subordinate, almost inferior” role, agrees Shannon Stocker, M.D., who suffers from complex regional pain syndrome (CRPS), This role easily may prompt an otherwise assertive individual to behave deferentially around doctors. “The sad thing is that society has fed into this dynamic,” Stocker says.

What’s more, Dillard adds, “There are a lot of doctors who are very smug about what they think they know. They expect people to just follow what they are saying, because they are the ones who went to medical school.” Doctors have been trained to think that they are authorities, given their scientific background and, therefore, “superior knowledge,” agrees Bonnie Cardenas, PT, who specializes in treating patients with complex, pain-related conditions. “Disagreement…is not to be tolerated.” 

Here’s how this dynamic can especially affect patients with chronic pain, who typically bounce from specialist to specialist: “Doctors give orders, and if patients do not follow those orders, the patients may  be branded as non-compliant, perhaps even defiant,” says Stocker.  When the “difficult patient” label is entered into a patient’s chart, Stocker says, it will makes every visit thereafter “one in which the physician goes into the meeting with preconceived notions, which may affect the treatment of the patient — leading to misdiagnoses.”

When a doctor expects a patient to be problematic, Stoker explains, the walls come up: “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. 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.”

Given this social reality, coupled with the fact that doctors are gatekeepers to medical treatment – ie, that a patient’s life very well may depend on a doctor’s good graces — doctors may end up expecting total compliance, and patients may end up delivering it.

Interested in this topic? Be sure to check out the Summer issue of Pain Pathways magazine, in which I explore the topic in-depth, in an article called, “The Good Patient Syndrome.”



Comments

Jennifer February 4th, 2011

I am currently struggling with the question of how assertive I should be with my doctor.  I am 36 weeks pregnant and my baby has not yet turned or dropped.  I have been informed that a c-section is pretty much inevitable and he wants to schedule it for 2 weeks before my due date.  I absolutely do not want a c-section, but when I told my doctor this, I was given the impression that I had no other options.  My intuition tells me that I should let nature take its course and give the baby some time to turn on its own, but with the scheduled c-section looming only a couple weeks away, I am worried baby won’t have the time it needs.  I feel so torn between “doctor knows best” and my very strong, and generally very accurate intuition.  Having this decision practically forced on me makes me feel like I have no power.  I remind myself that I have the right to say no, but can’t help feeling like I am being bad for not listening to what my doctor says.  Thanks for the article.  It has given me a little more courage to go with my gut.

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