Simon Murray, MD: My Problem Patients

A short account of patients I’ve known and not loved over the years.

About 10% of the patients in a primary care office create 90% of the problems. They consistently add to the workload with their unreasonable demands, rude and unpleasant disposition, or just plain craziness. Here are some of my most memorable problem patients.

1. I was on call one weekend and got a call at 3am from a man who said he was having terrible back pain. I asked him how long he had been suffering, and he told me he’d had it 2 weeks and had tried a variety of home treatments without success. He described his pain as 5/10 in intensity, which kept him from sleeping. I asked him why he had waited until this hour to call. He told me that he was starting to get nervous because the next day was the Super Bowl and he wanted to be sure he didn’t have pain during the game.

I explained that he needed to go immediately to a 24-hour pharmacy and buy Advil and Excedrin. Brand only. Also, a large jar of Salonpas. After he came home, he could take 1 Advil and 1 Excedrin every 4 hours. Take a hot shower then put the Salonpas all over his back. Then go outside and take a walk for 30 min. It was important that he do that. When he came home, he should do 40 partial sit-ups, put on more Salonpas, and go to bed. At 5am I called him to see how he was doing, and he wanted to know why I would bother him at that hour.

2. A woman called from Florida at 5am to say she was on vacation and had a urinary infection, and could I call something in for her? After the usual questions I was willing to prescribe antibiotics for her. I asked her if there were any pharmacies open at 5am, and she didn’t know. Did she have the number for any pharmacy? She didn’t and quickly asked me if I could possibly find one for her, look the number up, and call something in. She would be ok if I waited until 9am if nothing was open. I was impressed with her thoughtfulness.

3. A man called me at 2am to tell me he couldn’t sleep. I told him neither could I, now that he had woken me up. I told him a lack of sleep never killed anyone. He reported me to Aetna.

4. I had a patient who I thought was financially strapped, so I always made a point of discounting her visits. On the bill slip I would put down a nominal fee for her office visits. I never wanted her to think I was giving her charity because I sensed she was a woman with a good deal of pride and didn’t want to embarrass her. After several months I realized I hadn’t seen her for a while. When I ran into her in the supermarket, I asked her where she had been. She proudly told me that she had inherited some money and could afford a Princeton doctor now. Lesson: If you want to give someone a discount, make sure they know.

5. Drug seekers are difficult patients and often they can fool you if you are not careful. A woman came to see me stating she was looking for a new doctor. She said she would see me, but I had to prescribe 200 Vicodin tablets and 200 Valium tablets per month for her. I asked her why she needed those medicines. She said, “Because I like taking them.” I said, “wrong answer.” I suggested she stick with her regular doctor. She said she couldn’t because he was in jail. True story.

6. We all have patients with the C1 T10 syndrome. They see you once, call you 10 times asking more questions about their treatment and condition.

I then said, “how about seeing Dr. Smith?”

“I have heard bad things about Dr. Smith.”

“How about Dr. Beatty?”

“He’s too far from my house.”

“Wilson?”

“Too expensive.”

“How about Dr. Friedman?”

“Don’t you know any women doctors?”

“Yes, Dr. Pace, she excellent.”

“My niece goes there, and I don’t want to go to the same doctor.”

Exasperated now, “how about going to NYU, they have good doctors there.”

“I hate New York.”

Well then, I say, maybe you should look one up in the phone book.

She said, “why are you making me go to a cardiologist anyway? I don’t have any problem.”

7. There are a certain group of patients I am convinced were sent to make us crazy. They come with a seemingly simple question such as “Do you think I need to see a cardiologist?” When asked why they say all their friends have cardiologists. Knowing her well, I really didn’t think it was necessary since she didn’t have any problem. Didn’t I know that heart attacks are missed in women 50% of the time? Being a modern doctor believing in customer service I said sure, I was aware that heart attacks presented differently sometimes in female patients.

8. Here is the kiss of death. New patient. “Doctor I’ve heard so many good things about you. I’ve been to 40 doctors about my problem and they are all idiots. None can solve my problem. I fall for it every time. “Sure,” I say, “how can I help you?” After hearing the litany and making what I think is a genius diagnosis and plan, the patient leaves excited and happy that she finally has a solution. This lasts for about a week, then I’m number 41 on her list. It happens every time.

Simon Murray, MD, is an internist based in Princeton, NJ. The piece reflects his views, not necessarily those of the publication.Healthcare professionals and researchers interested in responding to this piece or contributing to MD Magazine® can reach the editorial staff here.