A Thank You to Nice Patients

July 12, 2011

Paul E. Sax, M.D.

Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.

Yesterday I saw one of my favorite long-term patients. She's just wonderful, and it's always a joy to see her. Here are some reasons:

  • She's uniformly nice -- not just to me, but to all the nurses and social workers and other support staff in our clinic.
  • She shows up on time for her appointments. Love that.
  • She's highly involved in her care, but doesn't try to make all the decisions. Example: when I proposed a medication change a few years back, she asked many thoughtful questions about the pros and cons of the change I was recommending. But she didn't then come back with reams of internet research questioning everything we'd already discussed. In other words, she gets it that I do this full time for a living, which means that she doesn't have to do the same.
  • Even though her kids call her all the time on her cell phone, she cuts the conversations short during our encounters. Then she politely apologizes for the interruption.
  • She's very appreciative. Each year around the holidays, I get a card thanking the staff and me for our care. I've saved every one (and pretty much all the cards I get from every patient, if they have a kind note in them).

The result of the above stellar behavior? I would do virtually anything to try and help her. Back in the late 1990s, when she was very sick with AIDS, one of my fellows said it best: "There's just something about her that makes you want to take care of her." Exactly.

Based on patients like this, I was drawn to this commentary over in JAMA entitled "Do Nice Patients Receive Better Care?"

It's a thoughtful piece, with no firm conclusion on the provocative question raised by the title. It's also a good addition to the whole, "variations in care" theme that has already been extensively studied related to race, sex, patient income, education, and other factors. Here's the big finish:

Clinicians are human and subject to the influence of bias. Patient behaviors will have a clear influence. It is important to recognize this phenomenon, put it in the proper context, and develop strategies for dealing with it to ensure that professional standards are met. On the other hand, nice patients and patients with nice families probably do receive a level of care that is perhaps at times well above the professional standard. Pretending that this phenomenon is not so is probably not helpful, and raises the next question -- is it wrong?

Wrong or not, I can assuredly tell you this: While we may not be able to prove that nice patients get better care, they certainly make being a doctor a whole lot more rewarding. And fun.

And I thank them for that.

Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.

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This article was provided by NEJM Journal Watch. NEJM Journal Watch is a publication of the Massachusetts Medical Society.


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