Blaming the Patient

Dan Haupt, M.D. Health Guide
  • A common bad habit doctors have when a treatment fails is to “Blame the Patient” by implying that the treatment plan failed for reasons that the patient could have prevented. “The medicine would have worked if you had taken it the way I told you to,” or “The medicine won’t make you gain weight if you control your eating,” or “You were going to get diabetes anyway, my medicine didn’t have anything to do with it,” are some examples of the kinds of statements they may make.

    Many times this behavior results from physicians not wanting to feel inadequate because their treatment plan wasn’t successful. Also, some doctors are offended when a patient tells them “That medicine didn’t do anything,” and feel the need to defend themselves. Usually this kind of behavior from a doctor is rare, and represents a departure from their usual professional demeanor. Everybody has good and bad days, so to speak. Of course, doctors who are always Blaming the Patient probably have some “issues” that may prevent them from being the best advocate for their patients.
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    Sometimes, however, the patient does deserve some of the blame when a treatment plan fails.

    This month, Gary Sachs (Director of the Bipolar Treatment Center at Massachusetts General Hospital), Don Goff (Director of the Schizophrenia Program at Massachusetts General Hospital), and I met with a group of private practice psychiatrists to help bridge the gap between our academic lives and their private practice lives. While discussing data that he recently presented at the American Psychiatric Association meeting in Toronto, Dr. Sachs made reference to some interesting findings that relate to my previous blog entry.

    In my last entry, I discussed the higher rates of cardiovascular disease in people with bipolar disorder (which was the main topic of discussion during our meeting).

    Dr. Sachs discussed some data that his group has collected regarding patient ‘nonadherence.’ Adherence is the concept of a patient accepting and following the recommended treatment plan (the old, no-longer-politically-correct term for this concept was ‘compliance,’ which was deemed too paternalistic).

    Dr. Sachs reported that the most common recommendation that patients in his bipolar clinic refused to follow was with blood collection to screen for risk factors for cardiovascular disease.

    Now, remember how I criticized physicians at the beginning of this entry for inappropriately blaming patients? Now I’m going to Blame the Patient.

    In our group at Washington University in St. Louis, we are coordinating an American Psychiatric Association Workgroup on Antipsychotic Medications and Metabolic Risk. Our goal is to improve the quality of care for people with major mental illnesses by bringing international public health attention to the issues of cardiovascular disease and mental illness.

    Given the struggles that we have undertaken to convince psychiatrists of the need to screen patients with major mental illnesses for cardiovascular disease, it is disheartening that patients themselves would sabotage these efforts by refusing to participate in screening for cardiovascular risk factors.

  • Don’t be nonadherent, noncompliant, or foolhardy in this matter. Follow your physician’s recommendations for cardiovascular risk factor screening. If your physician isn’t screening you for cardiovascular disease, insist that they do. If they don’t know what to check, you can ask that they use the Metabolic Screening & Monitoring Form that John Newcomer and I have created, published by Compact Clinicals. If you don’t, you’ll be giving health care professionals an excuse to Blame the Patient, and needlessly shortening your own life.
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Published On: June 27, 2006