Do Nice Patients Finish First?

As the authors of a commentary published by the Journal of the American Medical Association note, there’s been plenty of research on how to deal with difficult patients. So they decided to look at the flip side: how do physicians treat nice patients? Do they get better care?

It all depends on how you define “nice” and “better,” one of the authors, Allan Detsky, a professor in the departments of medicine and of health policy, management and evaluation at the University of Toronto. Generally patients who “communicate well, understand their problems, are able to make decisions, adhere to diagnostic and treatment plans, are pleasant and express gratitude for the services they receive” are more pleasant to treat than those who don’t, the commentary says, but the definition of niceness is still pretty subjective.

(Physicians know it when they see it — those are the patients to whom they give their home phone numbers.)

Moreover, “what’s nice in a social context may not be the same in a clinical” one, Detsky tells the Health Blog.

“Better” care might also mean a bunch of things, the commentary says. “It could include more care, less care, appropriate care, extensive follow-up, diligent searches for abnormalities or implementing a strategy of watchful waiting,” the authors write. In some cases a physician who felt she was going the extra mile for a patient she particularly liked could actually be doing harm, say, by looking so hard for problems that she turns up something that proves to be nothing but requires invasive tests.

In an ideal world, patients would choose a doctor with whom they had good chemistry, for lack of a better word. In the real world of limited choices and time, that doesn’t always happen.

Nor are physician preferences likely to be managed away with the same type of guidelines offered to physicians regarding difficult patients. All doctors (and patients) can do is be aware of the likelihood that patients perceived as “nice” may be treated differently from those who evoke the opposite reaction.

“Human nature is human nature,” says Detsky.

Bonus: Physicians May Heal Themselves Differently

Image: iStockphoto

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Government Public-Service Ad Features Sauna-Going Pig

By Laura Landro

Can a woman and a pig chillaxing in a sauna convey the importance of cooking pork thoroughly? How about showing a shopper faced with a choice of a single dress in an empty mall as a way to convince patients they need to learn about multiple treatment options?

Two government agencies are using those scenarios as part of public-service ad campaigns — created with the pro bono help of the Ad Council — to get across important health messages to consumers.

The USDA earlier this week launched a series of TV and radio ads about safe food preparation in anticipation of peak summer barbecue season, when foodborne illness can be a special danger. And the Agency for Healthcare Research and Quality today unveiled its own campaign to encourage patients to explore different treatment options after a diagnosis.

The USDA

Advice on Tweeting for New Medical Residents

The medical residents starting their training today belong to a generation that doesn’t think twice about broadcasting even intimate details of their lives via texts, Twitter and other social media.
That can get tricky when those doctors’ lives begin to include patients.
To help spark discussions of how residents can negotiate this new ground, the folks at the Mayo Clinic Center for Social Media have put together a video with advice from doctors who are active on Twitter, blogs, Facebook or other forms of social media.
The project “was born from this idea that there are currently no well-defined guidelines about digital behavior” for physicians, says Bryan Vartabedian, a pediatric gastroenterologist at Texas Children’s Hospital in Houston who appears on the video and who blogs at 33 Charts. “Our initial goal is to initiate a dialogue about professionalism by physicians” who have an online presence he tells the Health Blog.
Privacy violations are one big pitfall. While it’s desirable for physicians to discuss patient cases, when they do so on Twitter or Facebook they have to “recognize that they are having a conversation in a hallway, not in a conference room with the door closed,” says Victor Montori, a Mayo endocrinologist and medical director of the clinic’s social media center.
Even discussing patient cases without using names or identifying details is troublesome, says Vartabedian, because patients may see a post or Tweet and recognize themselves, particularly if it’s a rare or embarrassing condition. (He recently blogged about just such a case.) Not only might those details violate patient confidentiality, they erode trust and professionalism, he says.
Broadcasting purely personal activities can also affect a doctor’s professional image. Would you be totally confident in the ICU physician who just talked to you about your ailing mother if the first page of a Google search features a photo of him doing a keg stand?
Those hazards aside, it’s important for physicians to use Twitter and other online tools, the video emphasizes. Vartabedian says he uses Twitter to gather information, and that social media is also a valuable way of disseminating general information to patients.
Montori says institutions and practitioners can raise awareness about conditions or available treatments, and also to counteract misinformation floating around online. “A lot of my colleagues say they don’t have time for distractions” like social media, he says. “But if folks who are really on the front lines of care cannot engage in this space, their thoughts, insights and experience will not be flowing through the network.”
And meantime, Montori says, “the thoughts of those who aren’t that busy, or who are paid to be in that space” will dominate. “Patients are receiving what they think is a signal but in fact it’s noise,” he says.