Angry Doctor

Saturday, November 26, 2005

The Stupidity Factor

Once in a while a poster makes a comment that I think deserves a new post in reply. This time it’s Anonymous’ comment on the post on stupid patients.

I’ll deal with the comment in parts.

"This is quite disheartening. One would think that with all the intelligence & hard work that it takes to get accepted into medical school, the admissions comittee would at least choose people with a heart, some common sense, and the tiniest inclination of empathic understanding…"

Like I said before, it is vain to imagine that you can in fifteen minutes tell if a teenager has the makings of a good doctor. Or that he or she has not, for that matter. If someone is intelligent enough to get the grades to qualify for an interview, he or she is probably also smart enough to fake sincerity for fifteeen minutes.

"… whether it be towards one's own culture, or the remotest culture on the face of this globe."

Yes, I too detect a racist undertone in Dr Pezzi’s account*. However, to expect us to have an understanding of "the remotest culture on the face of this globe" is probably asking too much.

(* - Please read Dr Pezzi's comment and my apology for this remark.)

"I, on the other hand, may be part of the intellectually vacuous group of people who hope, forgive how utopian this ideology may seem,"

It may not be an ideology, but your expectation is utopian. Not so much in that you expect all doctors to be compassionate, but that you expect heart, some common sense, and empathic understanding to allow us to do our job well in the face of a patient who cannot provide answers to straightforward questions. Empathic understanding only gets you so far. With some patients what is needed is telepathic understanding.

" … that physicians are capable of creating change in the world around them without disregarding all those around & below them."

I don’t think Dr Pezzi is hoping to change the world by disregarding those around him. Note also that while Dr Pezzi was angry, he did not (as far as the account went) let that affect how he managed the patient.

Politically-incorrect as it is, I think I agree with him that 'stupid patients' do exist, and they are a risk to themselves and a drain on the healthcare system because they tend to need more healthcare (because of stupid decisions they make, be it lifestyle choices or non-compliance to treatment and medical advice) and take up more time of the healthcare providers.

It doesn’t sound like your problem until the day you are waiting to be seen at the A&E and the guy before you is someone who is suffering from the result of non-compliance to a medication and it’s taking the doctor fifteen minutes just to find out what illness he is taking them for.

So my first question is: do we have the moral courage to admit that some patients are stupid and that they consume more healthcare, at the expense of the others?

If we do, the next question is: what are we prepared to do about it?

Well, my theory is that there are two main classes of stupid patients: those who can’t help it, and those who can. Let’s call them Type I and Type II.

Type I patients can’t help being stupid, but most of the time they are allowed to go through the healthcare system repeatedly with no remedial action taken because no one bothers about them. They can’t really be held responsible for their own choices and actions, so someone must.

Who? The family, I say.

Because so long as we allow them to carrying on getting their prescription and going through the follow-up visit without any way to check if they are compliant with the advice or medication, so long will the family continue to allow themselves to think they are not being negligent.

Yes, negligent.

I think it’s negligent to let an elderly parent who is not in the best state of mind to take care of himself or herself to see a doctor on his or her own. (Experience tells me that these children who neglect their parents are the same ones who will kick up a fuss when something goes wrong, in an effort to compensate for their own guilt of neglecting their parents.) But those who live alone and without support? I guess that’s when we have to do the best we can and hope for the best…

And in some cases, I believe the doctor himself becomes negligent.

I once saw an old man who kept coming to the clinic every two months to get three months’ worth of medicine. When asked, he claimed that he was taking the correct dose. I could have just turned a blind eye and let him take another three months’ worth of medicine and possibly overdose himself (I'd be in another posting by then), but instead I told him I would not prescribe him any more medication unless he came with a responsible relative. The son came later loaded for bear but after I explained my reasons he agreed to collect the patient’s medication and parcel it in weekly doses to him and check on him to make sure he is not taking an overdose.

I think we as a profession must acknowledge that some patients are a danger to themselves and should be supervised, and that we should have a right to refuse to continue seeing them unsupervised if their care is compromised. Controversial, I know, but we don’t let children sign consent forms for surgery either.

As for Type II patients, they are the ones I typically deal with in my stories. They are not really stupid, but choose to persist in immature thought patterns because they get away with it. Because doctors do not challenge them when they persist in unhealthy lifestyle choices, or remain non-compliant to treatment or advice.

Different doctors deal with them differently, and of course each patient calls for a different approach. I don’t think there is a universal solution here, but admitting that they are a problem and that we should not reinforce their immature thinking would be a start.

I know in the private sector standing your ground may mean a loss in business. That is unfair to the doctors who try to 'change the world', but that reality may soon change when the Health Ministry starts auditing all practitioners.

As for Anonymous, my last words are for you:

From my point of view, there are a few things you can do to help improve the situation:

1. Continue to demand that doctors should be people of heart and common sense. Yes, it is your right.

2. Take responsibility for any stupid patient in your family, if there is one. Go with him or her to the doctor to make sure he or she gets the best care.

3. Go to medical school and make a difference.

Thank you.


  • 3. Go to medical school and make a difference.


    er...sorry...had to compose myself.

    that was what i once thought about myself but, alas, me is too weak to resist disillusionment...

    By Blogger andrew, At November 26, 2005 6:31 pm  

  • Everybody makes a difference, Andrew.

    I know you believe that.

    By Blogger angry doc, At November 26, 2005 6:52 pm  

  • Don't kid yourself, we don't have any "Albert Schweitzers" here.

    By Blogger uglybaldie, At November 26, 2005 10:27 pm  

  • We don't all have to be Albert Schweizters or Mother Theresa to do some good in other people's lives.

    Take your GP for example, uglybaldie. Don't you think he makes a difference?

    By Blogger angry doc, At November 26, 2005 10:33 pm  

  • Most certainly he is a cut above the rest and makes a difference insofar as I am concerned. I suspect that we have a very good working relationship because I don't happen to be a "stupid" patient. But it is a given that day in and day out, he meets mostly "stupid" patients and if I may read his mind, he is probably wondering why he is cooped up in that clinic of his for at least 10 hours a day making what a stockbroker makes with just one deal.

    By Blogger uglybaldie, At November 26, 2005 10:47 pm  

  • I've to admit that I'm one of those stupid patients who indulge in spicy and acidic food even thought I'm done with gastritis and this is on top of the fact that I persistently refuse to take he medicine that is prescribe to me since I'm still a student and I don't want my friends to think I'm sicky and so on. So angry doc, kudos for being spot on with your observations. Being guilty of that, I now consult a doctor in private practice. :P Suppose it's not fair for taxpayers to suffer as because of my ignorance.

    By Anonymous Anonymous, At November 26, 2005 11:28 pm  

  • We seem to be just looking at one side of the coin and concentrating on "stupid" patients. Let me tell you that there are also horrendous stories of "stupid" doctors as well. Some of these square pegs in round holes are now waiters or insurance salesmen!

    By Blogger uglybaldie, At November 27, 2005 8:34 am  

  • Oh yes. Stupid doctors!

    Hey angry doc want to do a blog entry on that?

    But I'd say that in Australia, the standards of what a normal, and a stupid patients is very different from Singapore. In any case the standard of patients in Australia is much higher.

    In Singapore the majority of patients would fall under the category "stupid" when compared to the Australians.

    I think one problem is that in Singapore we don't have the culture to be responsible for one's health. Secondly the language is a problem. Somehow things get lost in translation when explaining metabolic syndrome and insulin resistance for instance. The chinese vocabulary of many Singaporeans is not surprisingly very poor.

    So in the land of the blind, the one eyed jack is King. What I'm trying to say is that if Dr Pezzi were to come to Singapore to work for a while, he'd probably lose all his hair after 1 month.

    By Anonymous Anonymous, At November 27, 2005 8:54 am  

  • Oh yes I forgot to add..

    IF Dr Pezzi has any hair to begin with! Hee Hee!

    By Anonymous Anonymous, At November 27, 2005 9:33 am  

  • Well said, Dr. Oz. You're going to replace my regular GP when he retires or strike Toto or if he comes into an unexpected inheritance or if he just want to be an ascetic in the Himalayan Mountains after dealing with all the stupid patients in Singapore.

    By the way, I lost all my hair having to deal with some really hair raising scary doctors!

    By Blogger uglybaldie, At November 27, 2005 10:08 am  

  • This blog is of course NOT balanced. :)

    I suppose the reason why I don't blog about stupid doctors is that I don't see them as 'stupid', but either as 'incompetent' or 'a stupid person who just happens to be a doctor'.

    There are some 'famous' doctors out there whose personality flaws are the stuff of legend and the talk of many a tea-room, but to blog about them would be to gossip. :)

    By Blogger angry doc, At November 27, 2005 10:20 am  

  • Hmm, uglybaldie,

    do you live in Oz or SG?

    By Anonymous Anonymous, At November 27, 2005 10:46 am  

  • angry doc,

    gossip leh. heh heh.

    By Anonymous Anonymous, At November 27, 2005 10:51 am  

  • 6 months here, 6 months there. Cool and rainy, I'm here. Hot and stuffy, I'm off.

    By Blogger uglybaldie, At November 27, 2005 10:52 am  

  • yeah, Angry Doc, let's hear some juicy tales about what goes on behind the septic facade of our health institutions. I mean stories on Docs, nurses, administrators waiting to be called to national duty in the cabinet and less on patients. We all know we are very very stupid leh.......

    By Blogger uglybaldie, At November 27, 2005 10:55 am  

  • Hmm.........

    I am so tempted to blog again....but I must resist that temptation.

    At least till I actually get to Oz


    By Anonymous Anonymous, At November 27, 2005 10:59 am  

  • you scared of what huh?

    keep away from race and politics and you'll be fine.

    The only thing you have to fear is fear itself.

    Blog on, Doc OZ, I sure will be your regular reader.

    By Blogger uglybaldie, At November 27, 2005 11:04 am  

  • Angry doc,

    We patients all know we are vely vely stupid leh.:-))

    The fool who knows he is a fool ain't no fool!


    By Blogger uglybaldie, At November 27, 2005 11:07 am  

  • hmmm,

    well not in Singapore. Singapore has this "case-by-case" policy.

    And I do want to have that good citizen and good standing certificate from the govt and SMC when I leave.

    So better play safe lah. You know right? This is SINGAPORE! dun play play. Pray also no use

    By Anonymous Anonymous, At November 27, 2005 11:08 am  

  • Ah, now they know you are only behaving when in Singapore ;)

    No lah, don't be paranoiac. Like playing football, don't kick the ball outside the OB markers ok. and you will be alright.

    Look, all games also got rules and regulations mah.

    Not like the angmoh, every thing goes that's why they are in such a mess.

    For me, it's 6 months of mess and chaos and 6 months of sanity and orderliness. That's why I am such a balance individual. LMAO.

    By Blogger uglybaldie, At November 27, 2005 11:25 am  

  • uglybaldie,

    have you seen the sedition act?

    and I think in Singapore the goal posts shift so much on a "case by case" basis.

    Better just not to play.

    By Anonymous Anonymous, At November 27, 2005 11:28 am  

  • Aiyah, I don't mind my grandchildren running all over my study or sit on my favourite meranti desk to play tikam tikam, but when they pour yakult into my computer monitor, I have to call in their disciplinarian , the grandma, no?

    By Blogger uglybaldie, At November 27, 2005 11:41 am  

  • Hard to say.

    Maybe Grandma will come and beat the kids up and punish them for running all over your study and sitting on your favourite meranti desk to play tikam tikam also besides just pouring yakult into your monitor cos SHE thinks they should even be doing that in the first place.

    Rules keep changing. Kids get confused. After a while kids just dun play.

    By Anonymous Anonymous, At November 27, 2005 11:52 am  

  • Grandma will come in, wave the feather duster wildly, gently slap their little chubby palms with the "cane", threaten them with no sweets or outings for the coming weekend and shoo them out of my den. Words spread fast. When their cousins come, they play, as childrens do but this time without upsetting the other occupants of the house.

    A few days later, it's the same old story again because children has short memories. And the circus repeats itself till they outgrow their childhood pranks. Secretly, I have been hoping they succeed with destroying the monitor because I've been eyeing the new LCD 19 inch for quite some time and the present workhorse refuses to die.

    By Blogger uglybaldie, At November 27, 2005 12:18 pm  

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