Medpage Today and ABC News developed this list of six things that drive doctors nuts.

However, the article ends with this:

“Yet while much ink is spilled on how to deal with the difficult patient, most doctors understand it’s not about them.

“Who cares? The patient is the center of care, not the physician,” said Scott Fields, MD, vice chairman of family medicine at the Oregon Health and Science University in Portland.

“This is part of what is wrong with how we provide care,” he said. “We need to be much more worried about why the patient does what he/she does and much less about how it affects us.” (Emphasis added)

Still, it is better if no one drives anyone else nuts, don’t you think? You may be surprised to see which behaviors made the doctors’ Top Six list.

Medpage Today

…Frustration No. 1: Meddling Families in the Room

The first time a young person goes into the checkup room alone can be a rite of passage, of sorts. But a small percentage of adults never take that step.

About 16% of all patients bring a companion — a spouse, adult child, parent, or friend — to their doctor’s appointments, according to a 2002 study in the Journal of Family Practice.

While many find that the comfort and support helps them through their appointment, the crowd can sometimes interfere with a doctor’s work or a patient’s well being.

“You get a husband and wife in a room, and one is overweight and one of them is not, and the other starts saying, ‘See, I told you so,’ if you talk about weight,” said Keith Ayoob, EdD, a nutrition and obesity specialist at Albert Einstein College of Medicine in New York City.

Such distractions may impede the doctor’s ability to communicate, or the patient’s ability to discuss his or her symptoms.

TPR says: One expert suggested that doctors should make sure the patient actually wants the companion in the exam room, an excellent point. Some patients have over-bearing family members who hope to get the doctor to side with them and “make” the patient “see things” their way. If you know of a family member who is accompanying patients with this goal in mind, try to be helpful. Offer to go instead. Break up that pattern. This is most important with the frail elderly, who are dependent on more mobile adults in their lives. They often fear standing up to them.

It can be a godsend to have a companion go with a patient to a visit, but only if the patient chose the companion and the companion understands what he or she should and should not do to help.

Frustration No 2: Keeping Mum about the Herbs

“When it comes to most herbal supplements, the medical community and the general public may, indeed, have reached a fragile consensus — namely, that these remedies do not count as drugs.

“Doctors often discount the effectiveness of herbal supplements, and patients often believe that the so-called natural origin of these preparations sets them apart from other medications.

“But when it comes to drug interactions, doctors want to know what supplements their patients are taking — and patients aren’t always willing to fess up on their own.

“Often, if they don’t tell you what supplements they’re taking, it’s not until the point that they have a potentially serious reaction that you know they’re taking one that might interfere with their other drugs,” said John Sutherland, MD, director emeritus of the Northeast Iowa Medical Education Foundation.

TPR says: No matter whether it  is a pill, syrup, pellets or powder, if it goes down your throat, you tell your doctor about it. It does not matter whether it is prescribed or purchased. Doctors must know what you take. No exceptions.

Frustration No. 3: Quitting Medication Without Notice

“Just as doctors would like to know all of the medications, herbs, and supplements you start, they also like to know when you stop taking your medicine.

“Patients who stop their medications can cause headaches for more people than just their doctors.

“People who stop prescribed antibiotics before they’ve finished the course may only kill the most susceptible microorganisms, allowing more resistant strains to survive and infect others.

“Mood-altering medication can also be dangerous to quit without a doctor’s consultation. Benzodiazepines, in particular, now come with a warning against abrupt discontinuation.”

TPR says: There is a reason the prescription bottle says, “Take as directed.” Not, take until you change your mind. Not, take until you have some side effect and decide that’s worse than the problem you had. Not, take until you forget. If you are not tolerating a prescription well, call the doctor’s office and report that. They usually can help you make a substitution or deal with side effects appropriately. Stopping a medication without a doctor’s telling you to, that it is safe to do so, is a bad, bad idea. Millions make this mistake every day. Just because you feel better does not mean you are well.

Frustration No. 4: Change My Lifestyle? Must Be a Pill for That

“Most physicians recognize that recommendations about lifestyle frequently go unfollowed. Nevertheless, patients who seemingly refuse to do anything about their obesity leave many doctors frustrated.

“I sometimes feel like patients are telling me they want me to make them stop bleeding, but without pulling out the arrows stuck in their chests,” said Lee Green, MD, MPH, professor of family medicine at the University of Michigan in Ann Arbor.

“Obesity can lead to diabetes, high blood pressure, heart disease, and arthritis — especially in the knees, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Yet losing just 10% of a person’s body weight can delay or prevent some of these diseases.

“The most frustrating thing for me is patients whose lifestyle is making them miserable but they won’t change it,” Dr. Green said.

TPR says: This is a highly charged topic between patients and physicians. The obesity epidemic has only made a difficult topic even harder to talk about. Medically obese patients should not avoid doctors but, at the same time, they cannot expect doctors to “fix” a problem that only weight reduction can help. Many researchers are trying to understand obesity, which may turn out to be more complicated than originally thought. However, until then, each patient has to work with weight as part of a whole effort to stay well. Would that there were magic pills to promote weight loss and reduce the effects of excess weight on the body, but there are not. Doctors are as weary of weight problems as the patients who have them. Set realistic goals, small ones. Work toward them with your doctor’s help. Jane Brody’s Personal Health columns (NYT) include some articles about her earlier weight problems, the way she got it under control and the way that she has kept it under control for years. Check out her sound advice on The New York Times website: Jane Brody/Personal Health.

Frustration No. 5: Hi Doc, I Need a Prescription for . . .

“The U.S. is one of the few countries in the world that allows direct-to-consumer drug advertising. Since the FDA’s 1997 decision to let drug companies market pharmaceuticals to the masses (previous drug marketing was aimed largely at physicians), doctors have reported more patients asking about drugs than ever before.

“In some cases, it might be helpful. But doctors say patients who are simply sold on a drug can interfere with their own care.

“For me, what is most frustrating is when patients view doctors as simply a source of a signature for something they want, without really wanting the physician’s guidance or opinion,” said Thomas Schwenk, MD, chairman of family medicine at the University of Michigan.

“In fact, in a recent study in Archives of Internal Medicine, insistence on an unnecessary drug was physicians’ most common complaint about their patients.”

TPR says: It all depends on why the patient saw the ad and thought the doctor would immediately prescribe a medication. If they have been working on managing a symptom, one that is hard to keep under control, a new drug might be one both of them are eager to try. However, no patient can tell, based on pharmaceutical advertising,whether a new medication is right for the problem—-for any number of reasons. The patient may have to take one drug—not negotiable—-which is not safe when combined with the new drug in the ad. The problem here is not asking the doctor about new drugs, it is in using the advertising as if it were your doctor. Big Pharma’s biggest concern is keeping its stock-holders happy. Remember who Big Pharma’s most important patient is: Wall Street.

Frustration No 6: I’ll Take a CT Scan, MRI, and Strep Test, Please

“Although not quite as common as patients who demand medicine the doctor would not otherwise prescribe, doctors say plenty of patients also demand extra tests and procedures.

“This is the bias some patients have to just doing more, without any understanding of how more care is not only expensive, but actually often leads to complications, poor outcomes, and lower quality,” Dr. Schwenk said.

“Many patients who demand a specific test might have had bad experiences with a doctor in the past, or may be going through life stressors. There are many other reasons, including psychological problems such as borderline personality disorder, according to Drs. Hull and Broquet in their Family Practice Management article.”

TPR says: Think about it. Who loves having tests? We have them because that is the only way to get to the bottom of what’s wrong. Therefore, people who demand tests, a lot of them, have something else going on.

In addition to the borderline personality disorder patients mentioned above, the most extreme group of patients who demand tests—-and thankfully this is a very tiny percentage of all patients—-are those who suffer from Munchausen’s syndrome. Wikepedia says: “Münchausen syndrome is a psychiatric disorder wherein those affected feign disease, illness, or psychological trauma in order to draw attention or sympathy to themselves.” When it comes to Munchausen’s patients and tests, there are many cases in which they demand tests which would be too high-risk for them, perhaps even fatal. They press on.

We once had a patient who wanted to put a doctor on report for refusing to order a test which, the other faculty members agreed, most certainly would kill her. When we told her the faculty agreed with the doctor, she said she’d sue and left. Her doctor shook his head. “She won’t live long enough to sue. She will find somebody someone who will give in. She’ll be gone. It is very sad.” This woman also refused his efforts to encourage her to go in for a psychiatric evaluation.

Almost none of the patients the doctors quoted here are encountering are not Munchausen’s patients.

They are people who cannot trust their physicians for any number of complicated reasons.

If you and your doctor have been searching for a diagnosis, or you are really worried about yourself, sit down and talk about what tests could help the two of you find answers or, at least, rule in or out the most worrisome diagnoses.

Source: Medpage Today in collaboration with ABC News, June 23,2009