Are patients becoming more entitled?

A dangerous post, but a few pertinent issues which have been bothering me for a while!

I called her into my consulting room, thinking to myself “this is great, I’m doing well for time today, only 15-20 minutes late and it’s nearly the end of the workday!” She, however, did not meet my smile with a smile and in fact appeared to be quite upset and agitated. It was so obvious that she wanted me to ask “is something troubling you?” She let out a long discontented sigh and said “I was told I was next…and I’ve been waiting 20 minutes!” My first reaction was to be flabbergasted. I wanted and to say quizzically “and….?” I bit my tongue and said “you were indeed next; I am sorry you felt that the wait was unreasonable”.

I felt that this was one way to “get off on the wrong foot”, as our views were quite opposite in defining what was a reasonable wait for the doctor. I wonder what others think is reasonable in this circumstance? I recall waiting patiently for at least an hour every time we went to see my local GP, and this was not for a bulk billed appointment either. It was just the way it was, and we appreciated the care that they gave us.

In the outer suburbs of Melbourne I had a middle-aged lady as a patient, whose opening line to me, before she even sat on the chair, was “I hate doctors!” What a negative way to start! I know that dentists have had to deal with these negative attitudes for years, due to the generalised fear of dentistry which is rife in the community, but this was a new experience for me. I actually think I let out a small laugh because I was so taken by surprise at this statement!

If these two examples aren’t behaviourally poor enough, I might let you know about a patient’s partner who called me profanities at the top of her lungs in a public hospital when I was explaining politely why I would not increase a particular addictive medication. This sort of behaviour only makes it less likely that people, especially the doctor, will bend over backwards to help you. It wasn’t only unpleasant for all who were there but it was terrible behaviour which I am sad to say, seems to be becoming more and more prevalent in our communities.

On top of the above behavioural faux pas, it is common for me to hear “oh and will you bulk bill me today?” after a detailed appointment where multiple issues were dealt with, and it was clear the patient has paid $150 for their hair to be cut and coloured at least every 6-8 weeks. Can they not afford the $20-$30 gap? Do they completely devalue my service to them as a doctor? Do they put such a low value on their healthcare? Or do they not even think of these things and assume that all healthcare should be free? I sometimes feel guilty sending through the Medicare item number for billing by reception staff, but then I remind myself of the years of training that I have completed and the good service I pride myself in delivering, and I know that I shouldn’t be selling myself short. Patients who attend our clinic are advised of our fees upfront, so there should be no surprises when they get to the front desk to settle their account. There are patients who are routinely bulk billed in most clinics, such as children under 16, and others whom GPs might choose to bulk bill, for example, those who have returned for a review or results, but I don’t believe that this should be an expectation.

Thankfully, most patients I see are very reasonable and happy with the care they are provided; it is these people who make being a GP worthwhile at the end of the day.

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5 thoughts on “Are patients becoming more entitled?

  1. I bust a gut to run on time – and apologise if late. Biggest reason to run late – patients who turn up 20 mins late for a 15 min appt, or those who present with a list of problems – to deal with effectively in 15 mins may therefore require 2 mins per problem – which does noone justice.

    Billing should not be problematic. It took me a while to understand the system in Australia – but remember that the doctor charges a private fee…the Medicare rebate is the amount that the Govt underwrites. If the gap between a Drs fee and the Medicare rebate is high, then it is up to patients to pressure Govt to raise the Medicare rebate – it is there for patients, not to pay doctors.

    Edwin Kruys wrote about this – http://www.panaceum.com.au/doctor-do-you-bulk-bill/

  2. Hear hear, Mel!

    My favourite of all time was when I was working in an affluent inner city practice and saw a professional lady who was new to the practice. She came to see me because one of her friends was a patient of mine and had recommended me to her. During the consultation we dealt with SEVEN different problems, each of them worthy of a whole consultation eg depression, PR bleeding, headaches, abdominal pain and others I forget now. I spent 45 minutes with her because I felt that she needed my attention at the time but it did make me run late for the rest of the morning. I organised for her to have some investigations and clearly advised (and documented) for her to return for results. I charged a 36 even though it really should have been 44. She never came back and I found out some weeks later that she had refused to pay her account because she was upset that I hadn’t called her about her results! So some times its the people you work the hardest for who appreciate it the least.

    Thankfully, the vast majority of patients are lovely people who are appreciative of the quality care you give them. Sometimes you’ve just got to shrug your shoulders and laugh about the rest!

  3. You guys would have loved “Consutation Wars” – I recently did a 2 hour theatre-style teaching session with the local regs. Lots of fun – I got to role play the 16 worst / most uncomfortable types of patient encounters and they had to respond – interesting how subtle phrasing changes and body language come out in the heat of battle.
    Highly recommend for any training exercise with peers.
    Casey

  4. Aslo I highly recommend attending anything on Consultation / behavioural management by the “cognitive Institute” out of Qld, great stuff. Makes you recognise your own weaknesses and tendencies in conflicting communication / styles
    c

  5. Pingback: Do you wish you were Dr Incognito? | Not just a GP

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