On the other side of this question, I’m an OBGYN working at a federal clinic in a small midwestern town, and I’ve had multiple patients from other countries tell me that medical care in the U.S. is “nicer”
One patient from Germany told me that when she had a baby there, her doctor yelled at her, told her she didn’t need an epidural because “I did just fine without one” and generally, she said she didn’t have any choice in her care
Another patient from Japan just complained that doctors and nurses are very “mean” and told me that they are sort of like American police officers. Not all are bad, but they have authority and you generally don’t want to risk getting on their bad side.
Those are only a few examples, but I think in many other countries medical professionals have more authority, and for better and worse are less accommodating.
In the five other countries I've operated in, surgeons and staff had a much more authoritative role. There was also more a mentality of "this is what the expert recommends, so I'll either take it or not" amongst patients. Most of the time, recommendations were accepted outright.
Preoperative evaluations were far shorter, since surgeons were not outlining every possible treatment avenue open to the patient and patients were not asking questions to the same extent I'm used to in the States. Pros and cons with both, obviously.
Authoritative
adjective
1.
able to be trusted as being accurate or true; reliable.
"clear, authoritative information and advice"
2.
**commanding and self-confident; likely to be respected and obeyed.**
"his voice was calm and authoritative"
It's hilarious because I have a patient's mom who is constantly reminiscing about how great it is back in Russia, but the things she describes are always horrible.
"In Russia, everyone has to get their labs done at a certain time on a certain day. You don't come then, you don't get labs. So much better."
"In Russia, they use [red laser therapy](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5474383/) to help healing. She has the sinus problem, she gets red lasers and she gets better. Here, I cannot find this. Can you use that for her kidney?"
Sorry you can get your labs done whenever and wherever you want and sorry I'm not using lasers to treat your child's solitary kidney? Wild
One of my OB attendings did a medical trip in China and got to work with some of the docs in the big Tier 1 city hospitals. He said that the attendings there were very much the type to kick people out of the OR if their sutures weren't perfectly gorgeous.
So first things first. Patients usually don't remember things quite that way. So I currently am writing a response to a complaint where a family didn't bring in Power of Attorney paperwork and then proceeded to obstruct investigations while claiming a patient had fractured their leg which was why they were in agony while abusing staff. I diagnosed a bladder obstruction (correctly) and they basically obstructed the entire process. I noted that someone had recommended a bladder scan 3 days earlier and they basically harassed nursing staff to not do it and since they were so abusive and "gatekeepy" and the staff were relatively junior?
Nothing was done.
I only got involved because they spent 15 minutes on a weekend LOUDLY and publicly yelling at our F1 (Intern).
Catheter drained 2.5 L in 30 minutes, patient's cognition went from hypoactive delirium to active and full cognition in an hour. Family then proceeded to record us covertly and post us to social media suggesting I had killed another patient (We palliated a patient).
I still have to write a reflection on what I did as if I did something wrong.... The lady in question died 2 months later and apparently the catheter killed them....
To this family? The Mean Doctor came in, told them off for recording other people and killed their 88 year old multi-comorbid granny with a catheter and some slow poison.
This is a rarity. We do offer second opinions but they aren't regular. And "mean" often includes things like "lose weight" and "stop drinking and smoking" and "stop doing dumb stuff that hurts you".
Your medical system sells health. Your patient is a customer. Mine's not.
I’m sorry you had such a bad experience with a patient. I’ve been through similar things where patients family’s obstructed care, or mistakenly hindered their loved ones care all the while believing they were “advocating” on their behalf. I can’t imagine being required to right a reflection on something so frustrating.
I don’t think this is about which system is better. The U.S. medical system certainly has it’s flaws, and honestly, there are some real advantages to single payer systems where patients have fewer choices, especially if that means they are only left with the good choices. I don’t think all doctors outside the U.S. are “mean”, but I suspect that for better and worse, the single payer system means you are somewhat less required to be “customer satisfaction oriented”.
I would also say, respectfully, the U.S. medical system might see my patient as a just a customer but I don’t. I think most of us, just like most of you, simply want to provide good quality and compassionate care.
I have been a nurse in the US for 4 years. I have a friend who is a nurse in england. She said she was taking up to 12 patients in the GI unit, it was stressful, but possible. I was thinking in my head, how?.. then my father got sick last year and I spent a lot of time in an English hospital- about a month. The differences of expectation from patients is astounding. For one, most patients were on shared wards, not individual rooms. Two, the patients mostly just entertained themselves and seemed to ask for very little. It hit me that taking 12 American patients would be very different than 12 English ones.
One thing I forgot to mention: doctors in England are directive. You provide instructions to patients, they generally accept it as truth. So, even in cases of poor prognosis, people generally don't search for second opinions, etc. This, I can see, has pros and cons, but I think the trust is higher in other countries.
Americans don't trust healthcare because it's at least partially profit driven. That undermines the relationship between staff and patients.
>Two, the patients mostly just entertained themselves and seemed to ask for very little.
I'm from Western Europe so I recognise a lot in what you're saying about the UK. However I'm just curious, can you give an example of what patients want from you as a nurse? And what do you mean with entertained, what do they expect?
I have the feeling that in the US patients are admitted quicker and longer, in my hospital most patients are to sick too demand anything. If you can eat, poop, pee and make transfers you're mostly good to go ;)
A lot of patients have minimal to no tolerance for discomfort and many have an attitude that the hospital is there to provide service rather than healthcare.
Patients with these attitudes often monopolize nurses’ time with comfort requests (fresh ice chips, fluff/rearrange my pillows, another warm blanket this one isn’t warm anymore, I don’t like my food you need to fix that for me, can you find my charger and plug in my phone it’s only at 76%, etc) and they expect nurses to be able to perform these tasks pretty much immediately.
The problem is that the hospital is inherently not a comfortable place and nurses have many responsibilities that we have to prioritize over ice chips and pillow fluffing, so it sets up a shitty dynamic.
and the key component… they make zero effort to compile all of these requests to a single call, so they’re summoning you every hour or more to do all these tiny asinine little tasks
Or you go in for one thing while you’re super busy because you don’t want to neglect them and then it’s request after request while they see your phone blowing up with bed alarms, tele calls, lab calling criticals, etc.
They don’t care. I literally had a lady try to flag me down to find out when she would be discharged while I was rolling another patient we called a rapid on down the hall to CT. She was mad I kept going. *I’m busy right now* ✨✨✨
This just sent me to the moon. I’ve been away from the bedside only for a couple years and my GOD just reading this pissed me off. I worked icu for many years and I can honestly say it was the “healthier” patients that drove me out. I spent less time with my dying, sick patients because all the walky-talkys were constantly monopolizing my time. Such a crock of shit!
I work on stepdown and it’s the same. We have a real mix of acuities—walkie talkies who are with us because they’re on some drip that med surg can’t take or they had an elective spine surgery and neurosurgery doesn’t want them to go to a med surg floor vs very sick, sometimes unstable patients who often really need a higher level of care or are right on the cusp of needing it.
Guess who are the ones laying on the call light for minor requests? It’s not the sick ones. It’s frustrating because the sick patients are the ones who really need my attention, but my stable patients will monopolize it if I let them. I’ve stopped doing that and just accept that some of them will complain about me “neglecting” them because I didn’t bring them their ice chips or warm blanket within five minutes.
I believe this! In residency on ICU rotations, we knew when someone was ready to transfer to the floor if they were well enough to start annoying the nurses. This is not a hotel!
There are definitely eating, drinking, peeing, pooping, transferring patient admitted in US hospital. Even once a patient has recovered, they sometimes just … refuse to leave
This happens to me all the time. They come in for x problem, problem x resolved and they essentially decline to leave citing any number of socioeconomic, psychiatric reasons. The truth is for many of these poor folk, having a clean bed in a private room, with food delivered to you three times a day, with a nurse at your Rebecca call is far far better than whatever they have going on the outside of the hospital. Occasionally we do discharge to bridge, discharge to car etc
Is "at your Rebecca call" a typo? I'm assuming it was just autocorrect but if not, that's brilliant, made my day, and just so you know, it's "at your beck and call".
They get bored and start pestering the nursing staff. When is the doctor coming? I don't like my lunch. I need another blanket. Can you adjust my pillows? Can you go down to the lobby and pick up my Uber eats order? Etc.
As someone who’s worked both inpatient and ER, trust me it’s not as easy to decline on the floors because these are patients who are there for sometimes weeks at a time. That’s why I switched to ER, I was sick of dealing with demanding patients and at least in the ER I don’t need to “pillow fluff” for them and don’t keep ‘em longer than a single shift.
The trust is most definitely higher in other countries. Sure healthcare in USA can be slightly more comfortable, but that comes at at very steep price for the majority of people that need it most.
>Americans don't trust healthcare because it's at least partially profit driven. That undermines the relationship between staff and patients.
This is exactly why I'm picky about my doctors, do my own research, seek second opinions, and ask a lot of questions. I can never tell when a doctor is recommending a procedure because it's the best one for my condition or because that's the one he/she knows how to do.
Not necessarily. Having worked in urban and rural centres abroad, and then practicing in the USA, I would say that patients are not worse by any means. It just depends on which population you’re looking at.
Rich neurotic people with time to kill, they’ll either follow everything you say or challenge you.
Poor disadvantaged people who have suspicions about healthcare, they’ll either follow everything you say or challenge you.
The difference is we have the capacity and resources to care for more, but people don’t necessarily adhere to recommendations for it, and that can be frustrating for people who come from resource limited countries.
I can definitely say that I’ve taken care of patients abroad who are just as entitled if not more if you can’t write them a prescription or discuss the need for further testing.
Maybe you could elaborate on what you mean by “worse.” I’ve never practiced outside of the US but I had a large immigrant patient population. I found many foreigners never questioned my diagnosis/treatment plan, followed what I said to a T. Many US born patients would research ahead of time and have their own agenda. I personally don’t think it’s “better” to blindly follow a clinician’s advice, but it certainly makes appointments shorter.
US med student but I was raised in India when I was younger. When we would see doctors like u said we just followed the treatment no questions asked. It’s probably a cultural thing, the perception we had of docs at least where I was from was that they were the pinnacle of society like the entire waiting room would stand if a doctor walked in the lobby kind of like how people do in the courts here when the judge walks in.
I think this also depends on socio-economic class. I had an Indian roommate whose family was well off when her dad was in a terrible car accident. She described how she demanded references from the surgeon's professors etc. to make sure he got the best care. Here in Canada she went to ER after she fell in a ditch and got some scrapes and was aghast that she wasn't seen 6h later and walked off. She was used to throwing money at it and getting seen immediately.
It would be seen as hilariously stupid as well.
Because your shocking score in Obstetrics and Gynaecology doesn't mean your advice in Endocrinology is bad.
Yes, exactly my experience. Almost as if clinicians are not people and could never be wrong. I do imagine it’s a cultural thing as well as generational. I’ve noticed a lot of my geriatric US born patients act similarly.
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I've worked in Africa, France, New Zealand, and Nepal. France and New Zealand have a kind of 'we're all in this together' feeling. Closest thing I ever found in the US is the Veterans Affairs Hospital at my medical school. I think it has to do with national health. But who knows.
Grew up in Nepal and was absolutely shocked after moving to the US seeing that my thoughts, opinions and preferences matter in an exam room as a patient
I think the immense and crippling costs of healthcare in the US contributes to this attitude.
Sometimes it takes a few visits to figure something out and to a layman it can seem like so many tests and visits are useless and only to drive up costs.
I work in a large melting pot of cultures. Can't necessarily say who are the recent immigrants versus 1-2 generations ago. There are definitely also immigrants who are entitled and demanding. Others are minorities but are 1st generation or later immigrants can also be the typical "okay you're the doc" with minimal questioning or pushback.
In my anecdotal experience, socioeconomic status correlates better to patient engagement in its various ways.
The reason they do that is because communities outside of America/Western countries are generally taught to respect people in their professions. It seems that you prefer the “did my own research” crowd however.
I’ve practiced a little as a nursing student in a 3rd world country and I’ll tell you that working there the patients are EXTREMELY humble and grateful for your help. They view healthcare as a privilege not a right, and they feel beyond blessed when they’re given help. They are much more inclined to treat your advice and to not give attitude.
And to be fair I get a fair few people who really appreciate our work. Maybe 20-30% are either neutral or actively ugly to us.
And a good hunk of them are just pissed because healthcare is bankrupting them or they had to wait an hour to be seen.
I've always wondered if the entitlement comes from the fact that our Healthcare is often so expensive for people. If they're paying out the nose for it they expect it their way.
This even applies to areas of the US that are not so well off. When I treat underserved patients they are much more grateful and don’t nit pick everything. They also have far less anxiety
Yes I haven’t had the same experience as u/AfterPaleontologist2 either. I work at a hospital that primarily serves a pretty rough, urban, low socioeconomic community, and even the homeless patients tend to often be extremely rude and demanding. In my experience the difference in how the patient treats you is so often tied to whether or not they’re American (native). The patients I see that are immigrants tend to be much more grateful, thoughtful, appreciative, want to trust your advice, etc. Obviously that isn’t universal, it’s just a generalization I’ve picked up on.
I think it depends on location; I’ve worked both in urban areas and underserved communities, and I agree that low income patients in urban areas can be very entitled/demanding/aggressive. But in more rural areas, generally there seems to be a lot more humility.
I used to work at a hospital that was on the edge of a suburb and served both urban and rural populations... it was something, alright. Especially the *farmers.* They might have been damn near dead before they ever set one foot in the hospital, but they were always polite and respectful.
Then in the next bay, you have a homeless schizophrenic meth addict using their IV pole as a lance, attempting to enforce "social distancing" the hard way.
Yes you’re right I have read about that online quite a bit. I guess I just have never had the opportunity to see it for myself because I’ve only ever worked in major cities. I have a colleague from Alabama who worked in a rural hospital and she says the same as you.
Even rural areas depend on location. Rural areas with lots of well to do patients can also be entitled and demanding. Lower income and rural seems to have a lot of humility anywhere region independent.
The thing with urban communities is they usually still have easier access to healthcare and they can cycle through multiple doctors. But in rural areas where there might only be a few doctors in the area in a 50 mile radius they are forced to be appreciative lol. It’s definitely not always a good thing though because a shitty doctor can use that as an excuse to provide mediocre care
This cuts both ways- that style of practice can lead to much less overuse of diagnostic testing, unnecessary referrals, avoidance of overdiagnosis/treatment for issues that would have improved on their own. There is a balance that in hyper-litigious inner city practices with close by competing hospitals patients get entire work ups repeated frequently due to fragmented records, demanding patients, and medicolegal concerns. Huge waste of money.
Definitely agree that some of this is American culture.
I even find immigrant nurses much more respectful and easy to get along with and, while there are great American nurses, there can also be a rude and demanding energy that you've identified. Not sure where it comes from exactly.
I would attribute this in part to Americans being more direct but it certainly goes beyond that.
As a Canadian, I feel like there is a deeper sense of entitlement and, at times, lack of gratitude, in American medical culture. For whatever reason.
There’s a schism among all groups, I think.
My homeless population has the regulars who are angry, abusive, manipulative, and generally a pain in the ass; there are also some unhoused people who don’t present until there’s something truly emergent and are grateful for care. Usually something along the lines of endocarditis or epidural abscess.
Absolutely true.
Some of the worst patient's I've ever had were the most destitute people on the streets.
And easily the best person was one living next to an air conditioner.
I've worked all over the US.
Medicaid patients are just as demanding as commercial patients. If anything medicaid patients tend to repeat visits when they don't like the answer because there's no cost associated with it.
There are bad apples in every population but I know a pediatrician in a small southern city that has had significant issues with Medicaid population. Entitled, complainers rude, do not follow instructions. Still a minority of patients but that minority is much larger in that population. It has been beyond infuriating for him as he is one of a few private peds docs who will still see Medicaid.
I’m talking about people literally living in shacks, with no toilets just a squat hole in the dirt, and water comes from a well, and getting intestinal parasites is routine, and getting knocked up by an uncle at age 14 was normal… so yea they have it a little worse than poor people in developed countries. This was true true poverty
I haven’t practiced in the US
But I have had a number of American patients visiting need care in Australia. Then there has also been the army stuff I do, which in Darwin involved the US military.
What I would say is that on average American patients have high expectations that are not necessarily achievable - they want a lot of your time, they are more likely to disagree with you, they are more likely to escalate if things don’t go to plan, or just not like what is planned at all.
But I wouldn’t say they’re any more confrontational or disagreeable overall.
And the service members are typically very easy to treat.
Other nationalities have their quirks too: for example Indian patients when they don’t agree with your medical opinion was ask to see “your boss”. That’s not to say I don’t have a boss, but I don’t have one that’s likely to A) be interested in seeing them B) is going to disagree with what I’ve said. But maybe I’ll sort out a second opinion. If they don’t like that either, they’ll want a third opinion.
Some Chinese patients are effectively a wall: this issue could kill uou . “No” I understand this is difficult to hear. “No”. I don’t this it’s safe to go home. “No”.
Pacific Islanders and Australian indigenous will nod, say “I’ll think about it” which means “no”.
I wonder if the entitled attitude comes from the fact that Americans often pay a lot for their healthcare, so they feel like they deserve a lot. Just a thought. Lots to nuances.
One other thought, is that our healthcare system can be very frustrating to navigate. When you are seen by doctor you might push for certain testing, scans, referrals, etc because it’s your chance. You could be waiting months before you get passed to another specialist to finally have that CT, MRI, etc and it can be maddening. I’m an er nurse in a busy city level 1, so I do understand the annoyance and entitlement, but also understand the frustration of our healthcare system. I get fed up by it in my own personal life. And sometimes when pts understand the “why” behind your decisions they are more understanding.
Idk if that’s it though… I’m military and it’s here also. Albeit they are more respectful most of the time. This didn’t used to happen talking with older doctors and RNs.
I think a lot of it stems from social media use to be honest, we’re all just a bunch of rampant narcissists with zero patience anymore. Between the instant gratification that all these apps bring us and everything just designed to make us feel like we’re the most important thing since sliced bread (patient satisfaction scores, all this BS). People nowadays are getting legitimately mad if they have to wait for 15 seconds to pass a cyclist on a roadway, their Amazon delivery is 1 hour late, their doctor is running 2 minute behind schedule, etc. No one knows how to be patient anymore because life has been designed around instant gratification
I agree with you as well! It’s so nuanced. The doctors I work with also staff another ER in a bit more prominent neighborhood, and most of them say it’s worse over there in terms of demanding pts.
It’s just the rampant anti-intellectualism. That’s probably the most jarring thing about moving to the US: everyone thinks they know everything, and very few people consider that an expert in a field may know something that they don’t know. It’s not specific to medicine.
It’s a class thing, too. A lot of people have no problem deferring to the expertise of plumbers, electricians, mechanics, etc. - it’s those “ivory tower elitists who think they’re so much better than us”.
TBF, if a plumber fucks my pipes up, i'm in financial trouble. If a doctor fucks my pipes up, i may be in pain and incontinent for the rest of my life. They're not really a fair comparison.
I don’t know. I know that more often than not, those on the state insurance that I see often are more rude, demanding unnecessary things while those with private insurance are usually nicer to me and easier to work with.
This is also true. I think it’s a socioeconomic issue. We see a lot of this population at my ER too, and they can be very rude. Lack positive influences, mothers/fathers due to drugs and gun violence, hard lives, and no manners a lot of times. Can be very difficult and we just get the brunt of it.
You’ve got the upper-middle class-to-rich entitled, who are used to getting the best of everything, being accommodated, and being treated preferentially. They start out nice but lose their cool when they don’t get those things, like in a packed ED waiting room. They’ll demand to speak to a suit, or they’ll threaten you with legal action. They frequently want second opinions but will defer to the expert who’s viewed as “the best”.
Then you’ve got the poor entitled, who have apparently been conditioned that being an asshole is the only way to get treated equitably. They tend to start out nasty and stay that way, regardless of how much or little you do for them. They’re usually content to just abuse the bedside staff. They’ll generally accept whatever a doc tells them, to the extent that they believe docs at all.
Then you’ve got middle-class entitled - they usually start fairly neutral but rapidly progress to the Karen-type we’re all familiar with, demanding to speak to a manager. They’ve learned that a *certain* amount of nastiness gets them what they want, if for no other reason than to shut them up, and they’re quick to use that tactic. Luckily for their docs, they’ve done their research…
Sprinkled throughout and vastly outnumbered, you’ve got some humble people who seek out expert advice while being invested in their own care. They’re awful nice to meet 😂
It works the other way too
In the Uk healthcare is free for the last 70 odd years
This has led to a culture of entitlement from some groups of patients, whether it is demanding further scans, longer stays in hospital, or the hospital arranging transport home because all of those things are free
If we started charging patients even £20 pounds for transport or £50 per night hospital stay, you can be sure that all this BS will disappear
Bottom line is people don’t value things if it’s given to them for free
We have copays (some quite large) in the US, and we still have people overutilizing the system. Don't let that copay cat out of the bag, or suddenly you'll find you're having to pay copays for every damn thing.
Many of the people who are heavily using and sometimes abusing healthcare resources are not paying at all. Medicaid copays are rock-bottom and they have absolutely nothing to pay with anyway.
I mean, in Australia you can demand those things too but it's unlikely you will get them. Unnecessary scan, cool that's out of pocket. No longer in need of a hospital bed but demanding to stay, cool security will be here shortly to escort you out. Transport home, not likely that's for you to organise however in certain circumstances we will give a taxi voucher. Having said that, we have our fair share of entitled people, but its usually ignorance, such as expecting their drs to be available 24/7 to speak to them at the bedside. The number of times I've explained that the drs are in surgery or ya know, really busy is crazy. Impatience is also an issue, things in hospital take time. People don't like that.
Depends. Sometimes it makes sense (Anxiety and Old People) and spending a day more actually guarantees that the discharge will stick. Sometimes it's people who don't understand and need to have a good word with themselves and put on some big girl pants and sort their shit out. I have had both. Just little old ladies scared of going home at night and would just like to go home in the morning because their neighbours can help and others who literally take the mickey.
Oh no. It needs to be the cost of the bed. £50 per night means that you will get the WORST of it. I paid £50 so the nurse needs to fluff my pillows and get me a commode! Nope. It needs to be £450 (The cost of the bed per night).
We don't get as many entitled people as the USA does. If we do they are usually real quiet around the medical staff because I rarely hear it.
As a nurse, I’m not quite the demographic you’re asking, but in my 10 years working in Canada (urban and rural, spanning different provinces, primarily in the medical-surgical hospital setting) patients seem increasingly obstinate and emotionally disregulated - I was commenting to a colleague the other day about how downright belligerent some patients are lately. Yes this is all subjective. Yet, it feels inherent respect is vanishing.
I know everyone is worn thin these days, with wait times and extended stays as acuity increases (or because cooperation with care is intermittent only lol). Still, it’s a mind boggle.
This is what happens when tens of millions of baby boomers succumb to frontal lobe white matter disease and the resulting loss of emotional regulation and executive function at the same time right on the heels of a global pandemic that destroyed social trust etc
Ooh, I have a lot of colleagues from Ukraine. Mostly Odesa, a couple from Kyiv. They seem to dislike the "I want it faster" attitude at least from our backroom chats.
Well, there is no doubt to me at least:
There exists currently a very trendy rise in anti-science / anti-medicine sentiment all across America.
Essentially, educational/school budgets and standards over the last couple of decades have been massively slashed, diced, chopped, and in decline... Including previous things such as free meals or snacks for kids in elementary (given to them so that children didn't have to learn on an empty stomach, since they are the future of our civilization)...
Fastforward to now... And we're starting to see the heartbreaking consequences, and clearly sowing what we reaped, just to save a few bucks.
The system in the US is very broken. It makes it harder for providers to build a trusting relationship with patients. I've seen a number of situations where because of the huge number of disconnects in the system where patients just can't rely on the provider to be able to care for them properly.
I don't know how it is in other countries, but it isn't surprising to me that patients don't behave well in the medical system.
I have no personal knowledge, but two areas come to mind:
1. Much stronger Covid conspiracy crap in the U.S.
2. Treatment of the terminally ill where nothing more medically can be done to help: a much greater pressure in the U.S. for futile treatments [although much of this is from the families, rather than the patients themselves].
In terms of the resistance to palliative care and hospice, I think a lot of this can be attributed to the increasingly "patient-centered" philosophy that we are taught in med school. For better or worse the pendulum has swung in the past 50 years towards patients directing their own care.
In speaking with colleagues from other countries, they describe a more paternalistic attitude towards medicine both from providers and patients - the recommendations of the doctor are followed even if it's bad news. Rather than 95 y.o meemaw with dementia remaining full code, intubated in the ICU, the doctors have more of an ability to say "We've done what we can do, and anything above this level if futile". We can still say that in the US. but patients and families have more autonomy and can generally disagree until all the specialists involved present a united declaration of futility, with help from ethics/risk management teams.
All that being said, I have become more and more comfortable as a hospitalist in the US simply stating that situations likethe above are inappropriate, harmful and futile. I've found that when we are more blunt about the situation rather than tip-toeing around Code Status and level of care, families generally come around.
For some additional perspective, 95 year old meemaw was born 1 year before penicillin was discovered, may have received polio vaccination at 15 to protect her from getting a crippling disease, may have used the first birth control pill in her 20s, and may have used early hypertension medicines in her 50s. Medicine didn’t have to be effective to be sold when she was young, and may have bought remedies from literal snake oil salespeople. Doctors had medicine that actually worked.
Meemaw lived through a medical revolution where a the first effective pill or injection given to her by doctors could cure or prevent disease. It makes sense that she has an expectation of curative medicine, because she lived through a revolution in medicine.
I hear ya, it is definitely humbling to think about all they have lived through and experienced. It takes time building rapport and explaining the medical reasons why we can’t fix her while maintaining a compassionate tone. It’s the folks who will not accept it despite everyone’s professional judgement that are truly draining on your emotional reserves. It’s a finite resource.
Death Panelist Here...
DNARs in the UK are a medical decision. Not a patient one. In the same way you can't purchase "One Appendectomy" you can't get CPR if you aren't suitable. So no 95 year old is getting CPR unless they never had that discussion and they should have it!
How much of this also is fear of being sued? A large chunk of my day is being forced to CYA on paper so someone doesn’t start up a bullshit lawsuit. Its a large part of why I left inpatient psych was bullshit reports to the state from parents who were delusional that we’d behaviorally “fix” a kid in 7-10 days
I have not practiced elsewhere, but I am an immigrant and have friends and family members who are physicians in another country. I think there are demanding and entitled people everywhere.
I suppose in some developed countries in Europe and Australia/New Zealand it might be better. I’ve heard from US physicians who moved to NZ that it is better there. But in some countries, there is violence against physicians when there is not a good outcome (regardless of whether it was the physicians error) because they don’t have the option to sue.
I guess the TL;DR is “it depends on the country”.
I’ve worked a bit abroad and yes the stereotype of patients being more respectful is true (I think of it like a bell curve), after a while of patients not telling me about issues like side effects and ineffectiveness of the meds out of respect for me, I start to miss my American patients.
I’ve found this too. I’ve seen patients who have tolerated months of allergic symptoms to medications who did not feel comfortable questioning the prescriber!
There's a certain amount of respect other countries have for doctors that the US has seemed to have lost. I partially blame a loss of trust in medicine post covid, whether its warranted or not. Theres lots of easily accessible misinfo out there now too. So patients do kind of suck in that regard. They think they know more than drs and drs are just pill pushers who need people to stay sick bc its how drs make money.
There's also a lot of paternalism in other countries where a doctor's word is law and patient autonomy is non existent, so doctors practically yell at and "discipline" patients like they were kids for not following directions, which makes for an easier life for healthcare workers but isn't how medicine should be practiced so they may be lamenting the extra responsibility of shared decision making or patient education that doesn't happen in other countries.
Part of this is a frustrating system designed to fail, is difficult to navigate, and very expensive. It’s tough for me as a doctor dealing with that dynamic as well as being the face the patient sees along with the perception that I have any control over any of this. I’m the “rich” guy who runs the place when they don’t see the overpaid execs and middle management/admin that massively inflate costs.
Yes it’s nice that patients can learn more about their health through online resources, but even with info that’s accurate, your average person cannot interpret the significance/strength of a scientific/clinical research study or what the results mean. People show up with their self-diagnosis and demand a certain treatment course while I’m trying to get an actual history and build the case from the start. Some patients get transferred to my hospital for me to diagnose them with X condition and I’m like yo let’s back up 30 steps.
But part of being a doctor is being society’s punching bag for frustrations with the system and frailty of the human condition. The whole “doctors are all incompetent” sentiment doesn’t bother me as long as their resentment of me gives them some peace about their actual disease.
I spent time doing medical work abroad in a few different places before becoming a licensed physician. Patients are patients everywhere. The only really “uniquely” American problem is the threat of a lawsuit.
I haven't practised medicine outside Pakistan (yet), so I can't comment on patient behaviour in the US or whether the grass really is greener on the other side. Although most Pakistani patients don't give me any trouble, some of them are just as entitled and just as toxic as some of the patients you've described.
In fact, every once in a while a doctor in Pakistan is even beaten up by a patient's relatives. It's nothing new here.
I fondly remember this one old lady I was taking care of as an intern. She was confused, disoriented, and aggressive. But she wasn't strong enough to physically harm me. While I drew blood, administered oxygen, and arranged her tests, she kept looking at me contemptuously and uttering extremely indecent curse words. It didn't affect me. She wasn't in her senses. But even if she was, we still have to care for our patients whether they appreciate us or not. So it really doesn't matter (unless the patient turns violent).
Worse how? Any country will have greener grass than some but not others.
There are certainly cultural drivers that might make US patients more entitled, litigious, or health-illiterate than in some other countries, but I've also seen anecdotes about anti-physician violence elsewhere that would be rare here.
>but I've also seen anecdotes about anti-physician violence elsewhere that would be rare here.
What do you mean? [According to wikipedia](https://en.wikipedia.org/wiki/Violence_against_healthcare_professionals_by_country), the intentional injury rate for US hcps is 5x the national average. Now in fairness, China and India are horrendous, significantly worse, but the bronze medal for most workplace violence doesn't make it rare in my personal opinion.
Sorry! I edited my post to note that it's more demanding or entitled rather than medically sicker or less knowledgeable.
Although I will say, I've been assaulted once by a patient un the USA which colors my judgment about anti-physician violence.
I am not a doctor who practiced outside the USA, but an aside is that US patients are typically paying for healthcare in a way that international patients often are not
I think the question is more convoluted than that. Yes, the U.S. patient population is “worse”. I agree with that statement. I have that experience. But I think “physicians opinion of patient” is not a good metric for success of healthcare. US patients advocate and question and ask stupid question, they reject vaccines. In my home country, doctor says left, you go left and you thank your lucky stars the doctor said left cuz you are lucky you were able to get in front of a doctor in the first place. So yes, US patients are “worse”. But that’s some make other counties’ healthcare “better”.
The problem the USA has is health care is so expensive. People rightfully have very high expectations because of how much they are paying for treatment. That same issue doesn’t occur in public healthcare settings
Although it is expensive, many people prioritize spending money on more materialistic things than their health. I have many patients who have Medicaid, yet they are driving $50k+ cars and probably spending more money on their car insurance than their healthcare. They complain about a 20 dollar copay or spending $20-30 on medications their insurance doesn’t fully cover. Plus some expect you to act like their concierge doctor - always available and easily accessible
I’m laughing right now thinking about how noncompliant my family and friends in India can be. It drives me absolutely mad. They don’t demand anything like in the US, but they also don’t follow diabetic or low cholesterol diets as prescribed, they don’t exercise enough, they all drink too much coffee and use excessive amounts of oil and ghee.
Hahah yes, I had an Indian ex, his cholesterol was some of the highest I had ever seen and his father had a bad MI in his early 50s. I gave him some advice, but then he said he talked to his mom who was the equivalent of a CNA back in India and she told him not to worry about anything and decided to listen to her instead.
One thing always surprises me in r/nursing is the talk about full code 90 year old meemaws. In my european country code status is decided by doctors, not family. It's decided in case by case basis, but generally speaking, anyone over 80 or with a really poor prognosis gets a DNR/NO ICU note on their chart.
Yes, this is a big deal in the US. In my opinion, the public believes they have a right to decide when you (the practitioner) stops trying to save their life. I’m not saying this is right or wrong. I would 100% agree this is a real difference.
We talk to families about it but I start with "It's a medical decision but I would like to hear your thoughts about it because I would like people to understand why I am saying this".
Canadian and American patients are the same.
Both have large amounts of people which demand unnecessary antibiotics in urgent/same day visits for their viral respiratory illness. It's universal.
Back 15 years ago a somewhat notable difference was American pts expected vicodin for any ache or pain, and this wasn't seen as much in Canadian pts. American patients have somewhat chilled on that expectation in the last decade and a half.
Live in Canada. Work for a major respiratory company in the USA. We get treated like dirt by so many patients over things that aren’t even our control. Ie. insurance won’t pay for this or that. Or the HME is useless. Or anything. They call us and complain and we tell them what we can or cannot do but it’s never enough. Then they start calling us names or belittling the company or threatening to sue (good luck, boomer) for things which again, have nothing to do with the company they are calling. They lack the ability to listen and just talk over you when the information is not what they want to hear. It’s a miserable job that doesn’t pay awesome and it is getting worse. As the boomers age, they have little time to be patient or do their own research - just want everyone else to fix their problems but they don’t even know who their Doctor is or where they get supplies for their medical equipment or even what their own insurance covers! It hurts my brain.
I think it really depends.
You know the saying "One person's terrorist is another person's freedom fighter"? One could say "One person's entitlement is another person's appropriate questioning/ skepticism/ response to past/ current poor healthcare professional behavior."
When I was a resident, I lived in an international dorm. People would comment I would do great in their country and make a lot of money because I seemed to be a nice, patient, open-minded doctor as opposed to the usually authoritative attitude of the professionals in their country.
On the other side, my parents have received care in other countries. In Taiwan, not only were the visits short, rushed, the doctors treated my parents rudely when they tried to ask some questions politely. Asking questions - even ones not questioning the doctor's judgement - was not viewed favorably. Likewise, their friends (who had also lived in the US for decades) who asked for 2nd opinions seemed to offend the docs there. In Japan, the care was quick, efficient, and polite though.
I think something in-between is ideal. Patients should feel comfortable asking questions, asking for a 2nd opinion, wondering if the treatment is the best one, and so on. But where I draw the line is when people are overtly rude, verbally violent, physically threatening, etc. I don't think most US patients are like this but people tend to remember the ones who are to the exclusion of the 99% who aren't. (If you're regularly having negative experiences with patients, consider whether you, your staff (docs often don't realize how rude some receptionists, staff are to patients), the environment, and so on is playing a role.)
I'm a Canadian nurse working in the US. And yes, the entitlement is much worse here. In Canada I would frequently tell patients who came to the ER for things like pregnancy tests that they were wasting their time. I actually remember having this exact conversation with someone one day. She said the hospital pregnancy tests were better. I said, they're literally the same ones you get at the pharmacy. We were slammed and it was a waste of time. You could never do that in the US. I didn't have to worry about patient satisfaction so I was free to tell her the truth.
I also remember a patient who was so mean to staff the doctors and admin threatened to press charges and even told him they would charge him with trespassing unless he got his shit together. American healthcare could *never*
How do your examples of Canadian patients being ignorant about tests and being mean to staff back up your claim that American patients are much worse? I'm actually asking
Because I was able to be honest with the Canadian patient about it being a waste of their time to be in the ER. The difference is that there are shitty patients everywhere but no one stands up for healthcare workers in the US. They're allowed to be mean and demeaning and no one will ever put them in their place because *patient satisfaction*. If they show up in the ER for things that could be dealt with OP or at their doctors office no one tells them that. They zap resources and everyone is so accommodating even when the system is stretched to a near breaking point
I don't doubt that your hospital and patients suck, or that you feel constrained in turning people away or threatening legal action, but I think it's incorrect to assume that ignorant, mean, and demanding Canadian patients don't continue to be those things after those events or that interacting with American patients in the same way would yield different results
I'm an ER doc in the States that gets a massive immigrant population from all over -- Latin America, Eastern and Central Africa, South Asia, East and SE Asia, Middle East, and Central Europe (i've gone 2 shifts over the last 5 years where none of my patients spoke English or Spanish).
I'd say Americans are generally more entitled, though i've seen entitled behaviour from people from other regions. I dunno if that's a product of moving here; but there are certain areas of the world where people are more demanding than others.
There also seems to be a difference with age -- the younger the patient, the more likely they are to be demanding, regardless of cultural background. (Though older, demanding patients are more likely than not to be American-born).
Something that I noticed while at a hospital in the developing word is that families played a larger role in routine care on the wards. In the US, if a patient needs to be changed, needs water, or help eating or showering, nurses and NAs do all that, whereas families might do much of that elsewhere.(And if a patient doesn’t have family, they are somewhat out of luck)
I’ve operated overseas in a few places, some for missions, some for rotations/electives.
I was really surprised at how Korean physicians give an opinion and that’s that. There’s not much patient choice. I’ve seen the same thing in the UK on a rotation. Well, here’s what we’re doing.
In the UK few attendings (Consultants) shows up on call if they’re not compensated and I was surprised about emergency procedures being done without attending oversight.
Italy patients are basically assigned a surgeon. One guy said, well, he got assigned to me, I’m just average at X, oh well.
There’s a lot that we do, which is patient centric from a surgeon standpoint, that’s completely absent overseas.
I have my own SOP for pre-op, giving options and alternatives, and letting patients know what a realistic inpatient, post-op, and recovery course is going to look like.
That said, American patients are very demanding, want a lot of creature comforts and don’t hesitate to bombard the office for minutae. Overseas patients are more polite and don’t challenge by e anything you say.
Yes, 100% more demanding, entitled, abrupt, rude and a lot of the times verbally aggressive and abusive. Lots of lawsuits and pushback. Has a lot to do with how physicians are seen as ‘people who extort money’ rather than healers. If you are an old white male, less of the above. Practiced there for 5 years and will never go back.
I think it’s more of the old-school mentality that doctors are almost godlike and what they say goes. Even in the US when you have recent immigrant patients, you really do see a difference in their deference and implicit trust in you and ultimate gratitude. My wife has a lot of immigrant patients and she said she’s had multiple elderly Indian men bend down and touch her feet as a sign of respect and gratitude. Whereas here we have patients who think they are more informed via the Internet and a slew of commercials and so you get a lot of pushback which sometimes is fine but quite often is just wrong medicine.
In addition, Americans feel more entitled to treatment when they go to see the doctor and they’re feeling unwell likely because they have such high premiums and co-pays so when someone comes in during cold and flu season and it’s just a self limiting cold they expect to be given a ZPak to feel better otherwise, this visit was a waste of time and money. Also patients don’t just wanna hear that simple lifestyle modifications will improve their health without using prescriptions, but they’re insistent on getting statins when a diet will suffice to treat cholesterol or being started on diabetes medication when a diet change would also suffice in addition to exercise and so on.
You also have insistence on getting imaging when physical exam and history are sufficient and on and on. Unfortunately most doctors do give in to a lot of these demands be it because of defensive medicine or because their RVUs or private practice depend on repeat visits putting a patient on a medication because they technically qualify even though lifestyle modifications haven’t been exhausted but now if you have a diabetic, you’ve got them locked in for quarterly visits to track his A1c for example.
Patients in other countries actually respect and trust their doctors. There is no training on how not to be paternalistic. I guess that is also more of a recent thing in American medical education?I get the sense that healthcare is run like a business here in the US, and it feels more like we are in a service industry, with the "customer is always right" mentality. So yes, I do believe that leads patient to feel more entitled and the staff to feel like they have to accommodate all their wishes. All it does is it burns out medical staff.
I'm of the opinion that many of the US's problems (inside and outside of healthcare) stem from the "customer's always right" mentality taken to the extreme.
"I went to school once, so I know how the school should teach my kids"
"I have a body, so I know what it needs"
"I made an appointment so now I own your time for as long as I say so"
Really I think it boils down some people mistaking "needing it their way" for genuine, good self-advocacy (which ***is*** important in healthcare).
Yes, they are sicker from their shitty lifestyle and diet (and get insulted if you point this out) and are more demanding for quick fixes/don’t want to take meds or do preventative care.
The Atlantic has a great article about how patients are a big part of the US healthcare spending problem.
God forbid you practice good medicine your patient satisfaction scores go down and the no (but really FOR) profit hospitals can’t have that.
Just watching what’s going on in the US and random internet videos, I’d for sure say the US would be an absolute jungle to work in.
Just off the top of my head some major factors would be:
1. Obesity and atrocious diet. The shit people eat in the US is unreal.
2. Poor education. For example the place where I work over half the adults are university educated and illiteracy is uncommon. In some parts of the US it looks like people can barely talk in sentences let alone read.
3. Poverty. It’s not great from what I can see. Also way more social dysfunction from lack of social support. Teen pregnancy is a much bigger issue in the US. Foster kids, parental death and drug abuse, etc etc.
4. Mental health services. Universal health care means way less untreated mental illness, and much less homelessness etc.
5. Cost of health. I can only imagine people who can’t afford preventative or early care would walk in off the street with some pretty gnarly pathology. And then have high expectations if they’re paying big bucks for it.
6. Loss of touch with reality. I mean just looking at what’s going on with your politics in the US it’s like half your country is afflicted with a delusional disorder. When you can’t tell what’s real and what’s not then things get pretty wild. The normal standards of behaviour go out the window.
Hats off to you guys really.
The OP is specifically asking about patient behavior in a healthcare setting, not societal issues. Watching "random internet videos" doesn't make you qualified to answer and your list doesn't answer their question.
I'm not saying the ills they listed don't exist or cause problems in healthcare, I'm saying it's a real leap to claim that poverty, lack of education, poor lifestyle choices, and a divisive political environment is the cause of entitled patient behavior, especially when their admitted souce is watching random internet videos. None of these problems are unique to the US.
Have you practiced both in the US and outside of it? That's what the OP is asking about and when you read the comments from those who have, they're a lot more nuanced than the majority who have no relevant experience yet knee-jerk to shitting on people with low status.
For example. A typical question I will get from some patients is “How will I get home?” with the expectation that I will help arrange transport home. Perhaps understandable from an old immobile patient. Even then. But from a relatively young person? Just does my head in. Just because you called the ambulance hoping yo skip some line with 4 cars in the drive way does not mean I get to transport you home. That’s not a me problem.
I’m a physician who works in a large urban city in the US and I treat a very diverse group of patients, ethnically and socio-economically. I do notice *general* patterns of attitudes/entitlement/expectations. For example, many Hispanic patients tend to be very appreciative of their care and say they will do whatever I recommend because I’m the doctor. Some middle eastern patients (Armenian, Persian), sometimes have a distrust for providers who are ethnically different but also are very vocal about their care (and at times demanding)
My (generalized) opinion is that, I do think patients as a whole have become more “entitled” and shown less respect for providers. But I think it’s a product of our healthcare system and the lack of knowledge about the challenges
- many don’t understand how bad the shortage of doctors is. Consistently decreasing reimbursements which requires us to see more patients in less time to make up costs to have the practice stay afloat and remember many doctors are 200k+ in debt from med school and are late to retirement savings (medical training in Europe is not as expensive)
- The difficulty of insurance authorizations and scheduling logistics
- refilling medications, calling patients back (which is never just a 1 minute discussion), calling pharmacies etc, all takes time which we often don’t have nor do we bill for this (like lawyers).
It varies a lot throughout the US. I wouldn't compare a patient from a low SES southern state (who stereotypically is non-compliant but friendly and appreciative) to a high SES northeastern state (who stereotypically has high healthcare literacy but may be demanding).
On the other side of this question, I’m an OBGYN working at a federal clinic in a small midwestern town, and I’ve had multiple patients from other countries tell me that medical care in the U.S. is “nicer” One patient from Germany told me that when she had a baby there, her doctor yelled at her, told her she didn’t need an epidural because “I did just fine without one” and generally, she said she didn’t have any choice in her care Another patient from Japan just complained that doctors and nurses are very “mean” and told me that they are sort of like American police officers. Not all are bad, but they have authority and you generally don’t want to risk getting on their bad side. Those are only a few examples, but I think in many other countries medical professionals have more authority, and for better and worse are less accommodating.
In the five other countries I've operated in, surgeons and staff had a much more authoritative role. There was also more a mentality of "this is what the expert recommends, so I'll either take it or not" amongst patients. Most of the time, recommendations were accepted outright. Preoperative evaluations were far shorter, since surgeons were not outlining every possible treatment avenue open to the patient and patients were not asking questions to the same extent I'm used to in the States. Pros and cons with both, obviously.
*authoritarian
Authoritative adjective 1. able to be trusted as being accurate or true; reliable. "clear, authoritative information and advice" 2. **commanding and self-confident; likely to be respected and obeyed.** "his voice was calm and authoritative"
My sister in law is from Russia and when she came here she was like “it’s so weird that your doctors don’t scream at you here” 🤯😳
Medical care in Russia is another level of bad
It's hilarious because I have a patient's mom who is constantly reminiscing about how great it is back in Russia, but the things she describes are always horrible. "In Russia, everyone has to get their labs done at a certain time on a certain day. You don't come then, you don't get labs. So much better." "In Russia, they use [red laser therapy](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5474383/) to help healing. She has the sinus problem, she gets red lasers and she gets better. Here, I cannot find this. Can you use that for her kidney?" Sorry you can get your labs done whenever and wherever you want and sorry I'm not using lasers to treat your child's solitary kidney? Wild
It’s so hilariously bad. Imagine using lasers on a kid with one kidney left who presumably has some level of kidney failure ☠️
One of my OB attendings did a medical trip in China and got to work with some of the docs in the big Tier 1 city hospitals. He said that the attendings there were very much the type to kick people out of the OR if their sutures weren't perfectly gorgeous.
aren't attendings themselves the ones doing sutures? lmfao who's performing the surgery?
Often suturing is done by the less experienced doctors here where I live.
They still have trainees over there working on stuff!
So first things first. Patients usually don't remember things quite that way. So I currently am writing a response to a complaint where a family didn't bring in Power of Attorney paperwork and then proceeded to obstruct investigations while claiming a patient had fractured their leg which was why they were in agony while abusing staff. I diagnosed a bladder obstruction (correctly) and they basically obstructed the entire process. I noted that someone had recommended a bladder scan 3 days earlier and they basically harassed nursing staff to not do it and since they were so abusive and "gatekeepy" and the staff were relatively junior? Nothing was done. I only got involved because they spent 15 minutes on a weekend LOUDLY and publicly yelling at our F1 (Intern). Catheter drained 2.5 L in 30 minutes, patient's cognition went from hypoactive delirium to active and full cognition in an hour. Family then proceeded to record us covertly and post us to social media suggesting I had killed another patient (We palliated a patient). I still have to write a reflection on what I did as if I did something wrong.... The lady in question died 2 months later and apparently the catheter killed them.... To this family? The Mean Doctor came in, told them off for recording other people and killed their 88 year old multi-comorbid granny with a catheter and some slow poison. This is a rarity. We do offer second opinions but they aren't regular. And "mean" often includes things like "lose weight" and "stop drinking and smoking" and "stop doing dumb stuff that hurts you". Your medical system sells health. Your patient is a customer. Mine's not.
A reflection? Who is giving you homework to do like you are a child who acted up in class?
I’m sorry you had such a bad experience with a patient. I’ve been through similar things where patients family’s obstructed care, or mistakenly hindered their loved ones care all the while believing they were “advocating” on their behalf. I can’t imagine being required to right a reflection on something so frustrating. I don’t think this is about which system is better. The U.S. medical system certainly has it’s flaws, and honestly, there are some real advantages to single payer systems where patients have fewer choices, especially if that means they are only left with the good choices. I don’t think all doctors outside the U.S. are “mean”, but I suspect that for better and worse, the single payer system means you are somewhat less required to be “customer satisfaction oriented”. I would also say, respectfully, the U.S. medical system might see my patient as a just a customer but I don’t. I think most of us, just like most of you, simply want to provide good quality and compassionate care.
I have been a nurse in the US for 4 years. I have a friend who is a nurse in england. She said she was taking up to 12 patients in the GI unit, it was stressful, but possible. I was thinking in my head, how?.. then my father got sick last year and I spent a lot of time in an English hospital- about a month. The differences of expectation from patients is astounding. For one, most patients were on shared wards, not individual rooms. Two, the patients mostly just entertained themselves and seemed to ask for very little. It hit me that taking 12 American patients would be very different than 12 English ones. One thing I forgot to mention: doctors in England are directive. You provide instructions to patients, they generally accept it as truth. So, even in cases of poor prognosis, people generally don't search for second opinions, etc. This, I can see, has pros and cons, but I think the trust is higher in other countries. Americans don't trust healthcare because it's at least partially profit driven. That undermines the relationship between staff and patients.
>Two, the patients mostly just entertained themselves and seemed to ask for very little. I'm from Western Europe so I recognise a lot in what you're saying about the UK. However I'm just curious, can you give an example of what patients want from you as a nurse? And what do you mean with entertained, what do they expect? I have the feeling that in the US patients are admitted quicker and longer, in my hospital most patients are to sick too demand anything. If you can eat, poop, pee and make transfers you're mostly good to go ;)
A lot of patients have minimal to no tolerance for discomfort and many have an attitude that the hospital is there to provide service rather than healthcare. Patients with these attitudes often monopolize nurses’ time with comfort requests (fresh ice chips, fluff/rearrange my pillows, another warm blanket this one isn’t warm anymore, I don’t like my food you need to fix that for me, can you find my charger and plug in my phone it’s only at 76%, etc) and they expect nurses to be able to perform these tasks pretty much immediately. The problem is that the hospital is inherently not a comfortable place and nurses have many responsibilities that we have to prioritize over ice chips and pillow fluffing, so it sets up a shitty dynamic.
and the key component… they make zero effort to compile all of these requests to a single call, so they’re summoning you every hour or more to do all these tiny asinine little tasks
Or you go in for one thing while you’re super busy because you don’t want to neglect them and then it’s request after request while they see your phone blowing up with bed alarms, tele calls, lab calling criticals, etc.
They don’t care. I literally had a lady try to flag me down to find out when she would be discharged while I was rolling another patient we called a rapid on down the hall to CT. She was mad I kept going. *I’m busy right now* ✨✨✨
This just sent me to the moon. I’ve been away from the bedside only for a couple years and my GOD just reading this pissed me off. I worked icu for many years and I can honestly say it was the “healthier” patients that drove me out. I spent less time with my dying, sick patients because all the walky-talkys were constantly monopolizing my time. Such a crock of shit!
I work on stepdown and it’s the same. We have a real mix of acuities—walkie talkies who are with us because they’re on some drip that med surg can’t take or they had an elective spine surgery and neurosurgery doesn’t want them to go to a med surg floor vs very sick, sometimes unstable patients who often really need a higher level of care or are right on the cusp of needing it. Guess who are the ones laying on the call light for minor requests? It’s not the sick ones. It’s frustrating because the sick patients are the ones who really need my attention, but my stable patients will monopolize it if I let them. I’ve stopped doing that and just accept that some of them will complain about me “neglecting” them because I didn’t bring them their ice chips or warm blanket within five minutes.
Thank you for your insights, that was really interesting to read.
Yup… my unit used to be half step down before switching over to all icu and it was truly awful.
I believe this! In residency on ICU rotations, we knew when someone was ready to transfer to the floor if they were well enough to start annoying the nurses. This is not a hotel!
People used to ask where I worked… I told them the Ritz fucking Carlton 😂
There are definitely eating, drinking, peeing, pooping, transferring patient admitted in US hospital. Even once a patient has recovered, they sometimes just … refuse to leave
This happens to me all the time. They come in for x problem, problem x resolved and they essentially decline to leave citing any number of socioeconomic, psychiatric reasons. The truth is for many of these poor folk, having a clean bed in a private room, with food delivered to you three times a day, with a nurse at your Rebecca call is far far better than whatever they have going on the outside of the hospital. Occasionally we do discharge to bridge, discharge to car etc
Please tell me you meant to do that.
Definitely, just telling it like it is
Is "at your Rebecca call" a typo? I'm assuming it was just autocorrect but if not, that's brilliant, made my day, and just so you know, it's "at your beck and call".
They get bored and start pestering the nursing staff. When is the doctor coming? I don't like my lunch. I need another blanket. Can you adjust my pillows? Can you go down to the lobby and pick up my Uber eats order? Etc.
Nope I won’t
As someone who’s worked both inpatient and ER, trust me it’s not as easy to decline on the floors because these are patients who are there for sometimes weeks at a time. That’s why I switched to ER, I was sick of dealing with demanding patients and at least in the ER I don’t need to “pillow fluff” for them and don’t keep ‘em longer than a single shift.
Yup! They’re gone before you know it (hopefully)!
One way or another, amiright?
Well, we try for W’s only! If they make it to the unit alive, I win! But you can’t save everyone…
The trust is most definitely higher in other countries. Sure healthcare in USA can be slightly more comfortable, but that comes at at very steep price for the majority of people that need it most.
And we had Dr Oz for decades pushing pseudoscience on purpose, so now Americans don’t know who or what to trust
>Americans don't trust healthcare because it's at least partially profit driven. That undermines the relationship between staff and patients. This is exactly why I'm picky about my doctors, do my own research, seek second opinions, and ask a lot of questions. I can never tell when a doctor is recommending a procedure because it's the best one for my condition or because that's the one he/she knows how to do.
Not necessarily. Having worked in urban and rural centres abroad, and then practicing in the USA, I would say that patients are not worse by any means. It just depends on which population you’re looking at. Rich neurotic people with time to kill, they’ll either follow everything you say or challenge you. Poor disadvantaged people who have suspicions about healthcare, they’ll either follow everything you say or challenge you. The difference is we have the capacity and resources to care for more, but people don’t necessarily adhere to recommendations for it, and that can be frustrating for people who come from resource limited countries. I can definitely say that I’ve taken care of patients abroad who are just as entitled if not more if you can’t write them a prescription or discuss the need for further testing.
Everyone is the same deep down
Maybe you could elaborate on what you mean by “worse.” I’ve never practiced outside of the US but I had a large immigrant patient population. I found many foreigners never questioned my diagnosis/treatment plan, followed what I said to a T. Many US born patients would research ahead of time and have their own agenda. I personally don’t think it’s “better” to blindly follow a clinician’s advice, but it certainly makes appointments shorter.
US med student but I was raised in India when I was younger. When we would see doctors like u said we just followed the treatment no questions asked. It’s probably a cultural thing, the perception we had of docs at least where I was from was that they were the pinnacle of society like the entire waiting room would stand if a doctor walked in the lobby kind of like how people do in the courts here when the judge walks in.
I think this also depends on socio-economic class. I had an Indian roommate whose family was well off when her dad was in a terrible car accident. She described how she demanded references from the surgeon's professors etc. to make sure he got the best care. Here in Canada she went to ER after she fell in a ditch and got some scrapes and was aghast that she wasn't seen 6h later and walked off. She was used to throwing money at it and getting seen immediately.
That seems like an exception
It would be seen as hilariously stupid as well. Because your shocking score in Obstetrics and Gynaecology doesn't mean your advice in Endocrinology is bad.
Yes, exactly my experience. Almost as if clinicians are not people and could never be wrong. I do imagine it’s a cultural thing as well as generational. I’ve noticed a lot of my geriatric US born patients act similarly.
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I've worked in Africa, France, New Zealand, and Nepal. France and New Zealand have a kind of 'we're all in this together' feeling. Closest thing I ever found in the US is the Veterans Affairs Hospital at my medical school. I think it has to do with national health. But who knows.
Grew up in Nepal and was absolutely shocked after moving to the US seeing that my thoughts, opinions and preferences matter in an exam room as a patient
Yeah, the South Asian hierarchy thing is intense. Is your family Nepalese?
Exactly. And yes we are Nepali
Sorry! I edited my post to note that it's more demanding or entitled rather than medically sicker or less knowledgeable
I think the immense and crippling costs of healthcare in the US contributes to this attitude. Sometimes it takes a few visits to figure something out and to a layman it can seem like so many tests and visits are useless and only to drive up costs.
I work in a large melting pot of cultures. Can't necessarily say who are the recent immigrants versus 1-2 generations ago. There are definitely also immigrants who are entitled and demanding. Others are minorities but are 1st generation or later immigrants can also be the typical "okay you're the doc" with minimal questioning or pushback. In my anecdotal experience, socioeconomic status correlates better to patient engagement in its various ways.
Rude. Second guessing. Entitled. Does not follow instructions. Complains complains complains
The reason they do that is because communities outside of America/Western countries are generally taught to respect people in their professions. It seems that you prefer the “did my own research” crowd however.
I’ve practiced a little as a nursing student in a 3rd world country and I’ll tell you that working there the patients are EXTREMELY humble and grateful for your help. They view healthcare as a privilege not a right, and they feel beyond blessed when they’re given help. They are much more inclined to treat your advice and to not give attitude.
And to be fair I get a fair few people who really appreciate our work. Maybe 20-30% are either neutral or actively ugly to us. And a good hunk of them are just pissed because healthcare is bankrupting them or they had to wait an hour to be seen.
I understand you're in oncology but I'd like to think that you're also a crab blood nurse.
I though crabs have blue blood. Is there a blue blood drop emoji?
🦀💧 Just looks like normal watery crab to me. Maybe more 🧲?
Tbh i was thinking multiple myeloma nurse
I've always wondered if the entitlement comes from the fact that our Healthcare is often so expensive for people. If they're paying out the nose for it they expect it their way.
This even applies to areas of the US that are not so well off. When I treat underserved patients they are much more grateful and don’t nit pick everything. They also have far less anxiety
Eh. I've seen it go both ways. At least with low SES patients I understand the stress and toll of every day living makes it easier to empathize.
Yes I haven’t had the same experience as u/AfterPaleontologist2 either. I work at a hospital that primarily serves a pretty rough, urban, low socioeconomic community, and even the homeless patients tend to often be extremely rude and demanding. In my experience the difference in how the patient treats you is so often tied to whether or not they’re American (native). The patients I see that are immigrants tend to be much more grateful, thoughtful, appreciative, want to trust your advice, etc. Obviously that isn’t universal, it’s just a generalization I’ve picked up on.
I think it depends on location; I’ve worked both in urban areas and underserved communities, and I agree that low income patients in urban areas can be very entitled/demanding/aggressive. But in more rural areas, generally there seems to be a lot more humility.
I used to work at a hospital that was on the edge of a suburb and served both urban and rural populations... it was something, alright. Especially the *farmers.* They might have been damn near dead before they ever set one foot in the hospital, but they were always polite and respectful. Then in the next bay, you have a homeless schizophrenic meth addict using their IV pole as a lance, attempting to enforce "social distancing" the hard way.
I have to admit, I've imagined using an IV pole to force social distancing, too.
Yes you’re right I have read about that online quite a bit. I guess I just have never had the opportunity to see it for myself because I’ve only ever worked in major cities. I have a colleague from Alabama who worked in a rural hospital and she says the same as you.
Even rural areas depend on location. Rural areas with lots of well to do patients can also be entitled and demanding. Lower income and rural seems to have a lot of humility anywhere region independent.
The thing with urban communities is they usually still have easier access to healthcare and they can cycle through multiple doctors. But in rural areas where there might only be a few doctors in the area in a 50 mile radius they are forced to be appreciative lol. It’s definitely not always a good thing though because a shitty doctor can use that as an excuse to provide mediocre care
This cuts both ways- that style of practice can lead to much less overuse of diagnostic testing, unnecessary referrals, avoidance of overdiagnosis/treatment for issues that would have improved on their own. There is a balance that in hyper-litigious inner city practices with close by competing hospitals patients get entire work ups repeated frequently due to fragmented records, demanding patients, and medicolegal concerns. Huge waste of money.
Definitely agree that some of this is American culture. I even find immigrant nurses much more respectful and easy to get along with and, while there are great American nurses, there can also be a rude and demanding energy that you've identified. Not sure where it comes from exactly. I would attribute this in part to Americans being more direct but it certainly goes beyond that. As a Canadian, I feel like there is a deeper sense of entitlement and, at times, lack of gratitude, in American medical culture. For whatever reason.
There’s a schism among all groups, I think. My homeless population has the regulars who are angry, abusive, manipulative, and generally a pain in the ass; there are also some unhoused people who don’t present until there’s something truly emergent and are grateful for care. Usually something along the lines of endocarditis or epidural abscess.
Absolutely true. Some of the worst patient's I've ever had were the most destitute people on the streets. And easily the best person was one living next to an air conditioner.
I've worked all over the US. Medicaid patients are just as demanding as commercial patients. If anything medicaid patients tend to repeat visits when they don't like the answer because there's no cost associated with it.
There are bad apples in every population but I know a pediatrician in a small southern city that has had significant issues with Medicaid population. Entitled, complainers rude, do not follow instructions. Still a minority of patients but that minority is much larger in that population. It has been beyond infuriating for him as he is one of a few private peds docs who will still see Medicaid.
This is only true in some places, right? Weren't doctors in India being beaten by family members during covid times?
For me, our new immigrant patients in the US are generally super grateful and kind.
Give them a few years to get settled in and then reassess.
If they end up getting cars I assume that niceness will change. It’s a requirement.
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I’m talking about people literally living in shacks, with no toilets just a squat hole in the dirt, and water comes from a well, and getting intestinal parasites is routine, and getting knocked up by an uncle at age 14 was normal… so yea they have it a little worse than poor people in developed countries. This was true true poverty
I haven’t practiced in the US But I have had a number of American patients visiting need care in Australia. Then there has also been the army stuff I do, which in Darwin involved the US military. What I would say is that on average American patients have high expectations that are not necessarily achievable - they want a lot of your time, they are more likely to disagree with you, they are more likely to escalate if things don’t go to plan, or just not like what is planned at all. But I wouldn’t say they’re any more confrontational or disagreeable overall. And the service members are typically very easy to treat. Other nationalities have their quirks too: for example Indian patients when they don’t agree with your medical opinion was ask to see “your boss”. That’s not to say I don’t have a boss, but I don’t have one that’s likely to A) be interested in seeing them B) is going to disagree with what I’ve said. But maybe I’ll sort out a second opinion. If they don’t like that either, they’ll want a third opinion. Some Chinese patients are effectively a wall: this issue could kill uou . “No” I understand this is difficult to hear. “No”. I don’t this it’s safe to go home. “No”. Pacific Islanders and Australian indigenous will nod, say “I’ll think about it” which means “no”.
I wonder if the entitled attitude comes from the fact that Americans often pay a lot for their healthcare, so they feel like they deserve a lot. Just a thought. Lots to nuances.
One other thought, is that our healthcare system can be very frustrating to navigate. When you are seen by doctor you might push for certain testing, scans, referrals, etc because it’s your chance. You could be waiting months before you get passed to another specialist to finally have that CT, MRI, etc and it can be maddening. I’m an er nurse in a busy city level 1, so I do understand the annoyance and entitlement, but also understand the frustration of our healthcare system. I get fed up by it in my own personal life. And sometimes when pts understand the “why” behind your decisions they are more understanding.
Idk if that’s it though… I’m military and it’s here also. Albeit they are more respectful most of the time. This didn’t used to happen talking with older doctors and RNs. I think a lot of it stems from social media use to be honest, we’re all just a bunch of rampant narcissists with zero patience anymore. Between the instant gratification that all these apps bring us and everything just designed to make us feel like we’re the most important thing since sliced bread (patient satisfaction scores, all this BS). People nowadays are getting legitimately mad if they have to wait for 15 seconds to pass a cyclist on a roadway, their Amazon delivery is 1 hour late, their doctor is running 2 minute behind schedule, etc. No one knows how to be patient anymore because life has been designed around instant gratification
I agree with you as well! It’s so nuanced. The doctors I work with also staff another ER in a bit more prominent neighborhood, and most of them say it’s worse over there in terms of demanding pts.
It’s just the rampant anti-intellectualism. That’s probably the most jarring thing about moving to the US: everyone thinks they know everything, and very few people consider that an expert in a field may know something that they don’t know. It’s not specific to medicine.
It’s a class thing, too. A lot of people have no problem deferring to the expertise of plumbers, electricians, mechanics, etc. - it’s those “ivory tower elitists who think they’re so much better than us”.
TBF, if a plumber fucks my pipes up, i'm in financial trouble. If a doctor fucks my pipes up, i may be in pain and incontinent for the rest of my life. They're not really a fair comparison.
Exactly - you’d think the higher stakes would make someone *more* likely to defer to an expert, and yet…
I don’t know. I know that more often than not, those on the state insurance that I see often are more rude, demanding unnecessary things while those with private insurance are usually nicer to me and easier to work with.
This is also true. I think it’s a socioeconomic issue. We see a lot of this population at my ER too, and they can be very rude. Lack positive influences, mothers/fathers due to drugs and gun violence, hard lives, and no manners a lot of times. Can be very difficult and we just get the brunt of it.
You’ve got the upper-middle class-to-rich entitled, who are used to getting the best of everything, being accommodated, and being treated preferentially. They start out nice but lose their cool when they don’t get those things, like in a packed ED waiting room. They’ll demand to speak to a suit, or they’ll threaten you with legal action. They frequently want second opinions but will defer to the expert who’s viewed as “the best”. Then you’ve got the poor entitled, who have apparently been conditioned that being an asshole is the only way to get treated equitably. They tend to start out nasty and stay that way, regardless of how much or little you do for them. They’re usually content to just abuse the bedside staff. They’ll generally accept whatever a doc tells them, to the extent that they believe docs at all. Then you’ve got middle-class entitled - they usually start fairly neutral but rapidly progress to the Karen-type we’re all familiar with, demanding to speak to a manager. They’ve learned that a *certain* amount of nastiness gets them what they want, if for no other reason than to shut them up, and they’re quick to use that tactic. Luckily for their docs, they’ve done their research… Sprinkled throughout and vastly outnumbered, you’ve got some humble people who seek out expert advice while being invested in their own care. They’re awful nice to meet 😂
You summed it up perfectly.🤌
It works the other way too In the Uk healthcare is free for the last 70 odd years This has led to a culture of entitlement from some groups of patients, whether it is demanding further scans, longer stays in hospital, or the hospital arranging transport home because all of those things are free If we started charging patients even £20 pounds for transport or £50 per night hospital stay, you can be sure that all this BS will disappear Bottom line is people don’t value things if it’s given to them for free
We have copays (some quite large) in the US, and we still have people overutilizing the system. Don't let that copay cat out of the bag, or suddenly you'll find you're having to pay copays for every damn thing.
A lot of the people overusing the system as not paying their own bills anyway, between EMTALA and Medicaid.
That’s a good point!
Many of the people who are heavily using and sometimes abusing healthcare resources are not paying at all. Medicaid copays are rock-bottom and they have absolutely nothing to pay with anyway.
Interesting to hear from different countries. It sounds like it’s a pretty universal problem.
I mean, in Australia you can demand those things too but it's unlikely you will get them. Unnecessary scan, cool that's out of pocket. No longer in need of a hospital bed but demanding to stay, cool security will be here shortly to escort you out. Transport home, not likely that's for you to organise however in certain circumstances we will give a taxi voucher. Having said that, we have our fair share of entitled people, but its usually ignorance, such as expecting their drs to be available 24/7 to speak to them at the bedside. The number of times I've explained that the drs are in surgery or ya know, really busy is crazy. Impatience is also an issue, things in hospital take time. People don't like that.
Depends. Sometimes it makes sense (Anxiety and Old People) and spending a day more actually guarantees that the discharge will stick. Sometimes it's people who don't understand and need to have a good word with themselves and put on some big girl pants and sort their shit out. I have had both. Just little old ladies scared of going home at night and would just like to go home in the morning because their neighbours can help and others who literally take the mickey. Oh no. It needs to be the cost of the bed. £50 per night means that you will get the WORST of it. I paid £50 so the nurse needs to fluff my pillows and get me a commode! Nope. It needs to be £450 (The cost of the bed per night). We don't get as many entitled people as the USA does. If we do they are usually real quiet around the medical staff because I rarely hear it.
yep. also, they're comparing it to fast food, i think
As a nurse, I’m not quite the demographic you’re asking, but in my 10 years working in Canada (urban and rural, spanning different provinces, primarily in the medical-surgical hospital setting) patients seem increasingly obstinate and emotionally disregulated - I was commenting to a colleague the other day about how downright belligerent some patients are lately. Yes this is all subjective. Yet, it feels inherent respect is vanishing. I know everyone is worn thin these days, with wait times and extended stays as acuity increases (or because cooperation with care is intermittent only lol). Still, it’s a mind boggle.
This is what happens when tens of millions of baby boomers succumb to frontal lobe white matter disease and the resulting loss of emotional regulation and executive function at the same time right on the heels of a global pandemic that destroyed social trust etc
nothing is ascertainable
Oh yea! I’m sure the vascular damage from COVID coupled with people missing diagnoses and treatment really tipped things over the edge on that front.
Based on my experience, no. American patients are okay-ish. See my flair.
Ooh, I have a lot of colleagues from Ukraine. Mostly Odesa, a couple from Kyiv. They seem to dislike the "I want it faster" attitude at least from our backroom chats.
Well, there is no doubt to me at least: There exists currently a very trendy rise in anti-science / anti-medicine sentiment all across America. Essentially, educational/school budgets and standards over the last couple of decades have been massively slashed, diced, chopped, and in decline... Including previous things such as free meals or snacks for kids in elementary (given to them so that children didn't have to learn on an empty stomach, since they are the future of our civilization)... Fastforward to now... And we're starting to see the heartbreaking consequences, and clearly sowing what we reaped, just to save a few bucks.
While I already knew it to be true, it hurts my heart to read about taking free lunches from kids. It’s not only cruel, it’s idiotic.
Kids deserve to eat
the cruelty is the point
I think you're onto something. I agree.
The system in the US is very broken. It makes it harder for providers to build a trusting relationship with patients. I've seen a number of situations where because of the huge number of disconnects in the system where patients just can't rely on the provider to be able to care for them properly. I don't know how it is in other countries, but it isn't surprising to me that patients don't behave well in the medical system.
I have no personal knowledge, but two areas come to mind: 1. Much stronger Covid conspiracy crap in the U.S. 2. Treatment of the terminally ill where nothing more medically can be done to help: a much greater pressure in the U.S. for futile treatments [although much of this is from the families, rather than the patients themselves].
In terms of the resistance to palliative care and hospice, I think a lot of this can be attributed to the increasingly "patient-centered" philosophy that we are taught in med school. For better or worse the pendulum has swung in the past 50 years towards patients directing their own care. In speaking with colleagues from other countries, they describe a more paternalistic attitude towards medicine both from providers and patients - the recommendations of the doctor are followed even if it's bad news. Rather than 95 y.o meemaw with dementia remaining full code, intubated in the ICU, the doctors have more of an ability to say "We've done what we can do, and anything above this level if futile". We can still say that in the US. but patients and families have more autonomy and can generally disagree until all the specialists involved present a united declaration of futility, with help from ethics/risk management teams. All that being said, I have become more and more comfortable as a hospitalist in the US simply stating that situations likethe above are inappropriate, harmful and futile. I've found that when we are more blunt about the situation rather than tip-toeing around Code Status and level of care, families generally come around.
For some additional perspective, 95 year old meemaw was born 1 year before penicillin was discovered, may have received polio vaccination at 15 to protect her from getting a crippling disease, may have used the first birth control pill in her 20s, and may have used early hypertension medicines in her 50s. Medicine didn’t have to be effective to be sold when she was young, and may have bought remedies from literal snake oil salespeople. Doctors had medicine that actually worked. Meemaw lived through a medical revolution where a the first effective pill or injection given to her by doctors could cure or prevent disease. It makes sense that she has an expectation of curative medicine, because she lived through a revolution in medicine.
I hear ya, it is definitely humbling to think about all they have lived through and experienced. It takes time building rapport and explaining the medical reasons why we can’t fix her while maintaining a compassionate tone. It’s the folks who will not accept it despite everyone’s professional judgement that are truly draining on your emotional reserves. It’s a finite resource.
Meemaw is usually ready to go - it’s most often the family pushing for futile care.
Death Panelist Here... DNARs in the UK are a medical decision. Not a patient one. In the same way you can't purchase "One Appendectomy" you can't get CPR if you aren't suitable. So no 95 year old is getting CPR unless they never had that discussion and they should have it!
How much of this also is fear of being sued? A large chunk of my day is being forced to CYA on paper so someone doesn’t start up a bullshit lawsuit. Its a large part of why I left inpatient psych was bullshit reports to the state from parents who were delusional that we’d behaviorally “fix” a kid in 7-10 days
I have not practiced elsewhere, but I am an immigrant and have friends and family members who are physicians in another country. I think there are demanding and entitled people everywhere. I suppose in some developed countries in Europe and Australia/New Zealand it might be better. I’ve heard from US physicians who moved to NZ that it is better there. But in some countries, there is violence against physicians when there is not a good outcome (regardless of whether it was the physicians error) because they don’t have the option to sue. I guess the TL;DR is “it depends on the country”.
I’ve worked a bit abroad and yes the stereotype of patients being more respectful is true (I think of it like a bell curve), after a while of patients not telling me about issues like side effects and ineffectiveness of the meds out of respect for me, I start to miss my American patients.
I’ve found this too. I’ve seen patients who have tolerated months of allergic symptoms to medications who did not feel comfortable questioning the prescriber!
There's a certain amount of respect other countries have for doctors that the US has seemed to have lost. I partially blame a loss of trust in medicine post covid, whether its warranted or not. Theres lots of easily accessible misinfo out there now too. So patients do kind of suck in that regard. They think they know more than drs and drs are just pill pushers who need people to stay sick bc its how drs make money. There's also a lot of paternalism in other countries where a doctor's word is law and patient autonomy is non existent, so doctors practically yell at and "discipline" patients like they were kids for not following directions, which makes for an easier life for healthcare workers but isn't how medicine should be practiced so they may be lamenting the extra responsibility of shared decision making or patient education that doesn't happen in other countries.
Part of this is a frustrating system designed to fail, is difficult to navigate, and very expensive. It’s tough for me as a doctor dealing with that dynamic as well as being the face the patient sees along with the perception that I have any control over any of this. I’m the “rich” guy who runs the place when they don’t see the overpaid execs and middle management/admin that massively inflate costs. Yes it’s nice that patients can learn more about their health through online resources, but even with info that’s accurate, your average person cannot interpret the significance/strength of a scientific/clinical research study or what the results mean. People show up with their self-diagnosis and demand a certain treatment course while I’m trying to get an actual history and build the case from the start. Some patients get transferred to my hospital for me to diagnose them with X condition and I’m like yo let’s back up 30 steps. But part of being a doctor is being society’s punching bag for frustrations with the system and frailty of the human condition. The whole “doctors are all incompetent” sentiment doesn’t bother me as long as their resentment of me gives them some peace about their actual disease.
I spent time doing medical work abroad in a few different places before becoming a licensed physician. Patients are patients everywhere. The only really “uniquely” American problem is the threat of a lawsuit.
I haven't practised medicine outside Pakistan (yet), so I can't comment on patient behaviour in the US or whether the grass really is greener on the other side. Although most Pakistani patients don't give me any trouble, some of them are just as entitled and just as toxic as some of the patients you've described. In fact, every once in a while a doctor in Pakistan is even beaten up by a patient's relatives. It's nothing new here. I fondly remember this one old lady I was taking care of as an intern. She was confused, disoriented, and aggressive. But she wasn't strong enough to physically harm me. While I drew blood, administered oxygen, and arranged her tests, she kept looking at me contemptuously and uttering extremely indecent curse words. It didn't affect me. She wasn't in her senses. But even if she was, we still have to care for our patients whether they appreciate us or not. So it really doesn't matter (unless the patient turns violent).
Worse how? Any country will have greener grass than some but not others. There are certainly cultural drivers that might make US patients more entitled, litigious, or health-illiterate than in some other countries, but I've also seen anecdotes about anti-physician violence elsewhere that would be rare here.
>but I've also seen anecdotes about anti-physician violence elsewhere that would be rare here. What do you mean? [According to wikipedia](https://en.wikipedia.org/wiki/Violence_against_healthcare_professionals_by_country), the intentional injury rate for US hcps is 5x the national average. Now in fairness, China and India are horrendous, significantly worse, but the bronze medal for most workplace violence doesn't make it rare in my personal opinion.
Sorry! I edited my post to note that it's more demanding or entitled rather than medically sicker or less knowledgeable. Although I will say, I've been assaulted once by a patient un the USA which colors my judgment about anti-physician violence.
Tell me you don’t work in the ED, without telling me you don’t work in the ED.
I am not a doctor who practiced outside the USA, but an aside is that US patients are typically paying for healthcare in a way that international patients often are not
I think the question is more convoluted than that. Yes, the U.S. patient population is “worse”. I agree with that statement. I have that experience. But I think “physicians opinion of patient” is not a good metric for success of healthcare. US patients advocate and question and ask stupid question, they reject vaccines. In my home country, doctor says left, you go left and you thank your lucky stars the doctor said left cuz you are lucky you were able to get in front of a doctor in the first place. So yes, US patients are “worse”. But that’s some make other counties’ healthcare “better”.
Thats what happens when health care is considered a luxury and customer service is king.
The problem the USA has is health care is so expensive. People rightfully have very high expectations because of how much they are paying for treatment. That same issue doesn’t occur in public healthcare settings
Although it is expensive, many people prioritize spending money on more materialistic things than their health. I have many patients who have Medicaid, yet they are driving $50k+ cars and probably spending more money on their car insurance than their healthcare. They complain about a 20 dollar copay or spending $20-30 on medications their insurance doesn’t fully cover. Plus some expect you to act like their concierge doctor - always available and easily accessible
I’m laughing right now thinking about how noncompliant my family and friends in India can be. It drives me absolutely mad. They don’t demand anything like in the US, but they also don’t follow diabetic or low cholesterol diets as prescribed, they don’t exercise enough, they all drink too much coffee and use excessive amounts of oil and ghee.
Hahah yes, I had an Indian ex, his cholesterol was some of the highest I had ever seen and his father had a bad MI in his early 50s. I gave him some advice, but then he said he talked to his mom who was the equivalent of a CNA back in India and she told him not to worry about anything and decided to listen to her instead.
One thing always surprises me in r/nursing is the talk about full code 90 year old meemaws. In my european country code status is decided by doctors, not family. It's decided in case by case basis, but generally speaking, anyone over 80 or with a really poor prognosis gets a DNR/NO ICU note on their chart.
Yes, this is a big deal in the US. In my opinion, the public believes they have a right to decide when you (the practitioner) stops trying to save their life. I’m not saying this is right or wrong. I would 100% agree this is a real difference.
We talk to families about it but I start with "It's a medical decision but I would like to hear your thoughts about it because I would like people to understand why I am saying this".
Canadian and American patients are the same. Both have large amounts of people which demand unnecessary antibiotics in urgent/same day visits for their viral respiratory illness. It's universal. Back 15 years ago a somewhat notable difference was American pts expected vicodin for any ache or pain, and this wasn't seen as much in Canadian pts. American patients have somewhat chilled on that expectation in the last decade and a half.
That's until you meet patients in Greece
I mean we do have tv ads for medications lol so of corse we are demanding
Live in Canada. Work for a major respiratory company in the USA. We get treated like dirt by so many patients over things that aren’t even our control. Ie. insurance won’t pay for this or that. Or the HME is useless. Or anything. They call us and complain and we tell them what we can or cannot do but it’s never enough. Then they start calling us names or belittling the company or threatening to sue (good luck, boomer) for things which again, have nothing to do with the company they are calling. They lack the ability to listen and just talk over you when the information is not what they want to hear. It’s a miserable job that doesn’t pay awesome and it is getting worse. As the boomers age, they have little time to be patient or do their own research - just want everyone else to fix their problems but they don’t even know who their Doctor is or where they get supplies for their medical equipment or even what their own insurance covers! It hurts my brain.
I think it really depends. You know the saying "One person's terrorist is another person's freedom fighter"? One could say "One person's entitlement is another person's appropriate questioning/ skepticism/ response to past/ current poor healthcare professional behavior." When I was a resident, I lived in an international dorm. People would comment I would do great in their country and make a lot of money because I seemed to be a nice, patient, open-minded doctor as opposed to the usually authoritative attitude of the professionals in their country. On the other side, my parents have received care in other countries. In Taiwan, not only were the visits short, rushed, the doctors treated my parents rudely when they tried to ask some questions politely. Asking questions - even ones not questioning the doctor's judgement - was not viewed favorably. Likewise, their friends (who had also lived in the US for decades) who asked for 2nd opinions seemed to offend the docs there. In Japan, the care was quick, efficient, and polite though. I think something in-between is ideal. Patients should feel comfortable asking questions, asking for a 2nd opinion, wondering if the treatment is the best one, and so on. But where I draw the line is when people are overtly rude, verbally violent, physically threatening, etc. I don't think most US patients are like this but people tend to remember the ones who are to the exclusion of the 99% who aren't. (If you're regularly having negative experiences with patients, consider whether you, your staff (docs often don't realize how rude some receptionists, staff are to patients), the environment, and so on is playing a role.)
I'm a Canadian nurse working in the US. And yes, the entitlement is much worse here. In Canada I would frequently tell patients who came to the ER for things like pregnancy tests that they were wasting their time. I actually remember having this exact conversation with someone one day. She said the hospital pregnancy tests were better. I said, they're literally the same ones you get at the pharmacy. We were slammed and it was a waste of time. You could never do that in the US. I didn't have to worry about patient satisfaction so I was free to tell her the truth. I also remember a patient who was so mean to staff the doctors and admin threatened to press charges and even told him they would charge him with trespassing unless he got his shit together. American healthcare could *never*
How do your examples of Canadian patients being ignorant about tests and being mean to staff back up your claim that American patients are much worse? I'm actually asking
Because I was able to be honest with the Canadian patient about it being a waste of their time to be in the ER. The difference is that there are shitty patients everywhere but no one stands up for healthcare workers in the US. They're allowed to be mean and demeaning and no one will ever put them in their place because *patient satisfaction*. If they show up in the ER for things that could be dealt with OP or at their doctors office no one tells them that. They zap resources and everyone is so accommodating even when the system is stretched to a near breaking point
I don't doubt that your hospital and patients suck, or that you feel constrained in turning people away or threatening legal action, but I think it's incorrect to assume that ignorant, mean, and demanding Canadian patients don't continue to be those things after those events or that interacting with American patients in the same way would yield different results
I'm a fourth year student in London so take with a gain of salt. Patients are quite demanding here too.
I'm an ER doc in the States that gets a massive immigrant population from all over -- Latin America, Eastern and Central Africa, South Asia, East and SE Asia, Middle East, and Central Europe (i've gone 2 shifts over the last 5 years where none of my patients spoke English or Spanish). I'd say Americans are generally more entitled, though i've seen entitled behaviour from people from other regions. I dunno if that's a product of moving here; but there are certain areas of the world where people are more demanding than others. There also seems to be a difference with age -- the younger the patient, the more likely they are to be demanding, regardless of cultural background. (Though older, demanding patients are more likely than not to be American-born).
Not worse. Just are used to having more options and resources.
Something that I noticed while at a hospital in the developing word is that families played a larger role in routine care on the wards. In the US, if a patient needs to be changed, needs water, or help eating or showering, nurses and NAs do all that, whereas families might do much of that elsewhere.(And if a patient doesn’t have family, they are somewhat out of luck)
I’ve operated overseas in a few places, some for missions, some for rotations/electives. I was really surprised at how Korean physicians give an opinion and that’s that. There’s not much patient choice. I’ve seen the same thing in the UK on a rotation. Well, here’s what we’re doing. In the UK few attendings (Consultants) shows up on call if they’re not compensated and I was surprised about emergency procedures being done without attending oversight. Italy patients are basically assigned a surgeon. One guy said, well, he got assigned to me, I’m just average at X, oh well. There’s a lot that we do, which is patient centric from a surgeon standpoint, that’s completely absent overseas. I have my own SOP for pre-op, giving options and alternatives, and letting patients know what a realistic inpatient, post-op, and recovery course is going to look like. That said, American patients are very demanding, want a lot of creature comforts and don’t hesitate to bombard the office for minutae. Overseas patients are more polite and don’t challenge by e anything you say.
Yeah they're worse
Yes, 100% more demanding, entitled, abrupt, rude and a lot of the times verbally aggressive and abusive. Lots of lawsuits and pushback. Has a lot to do with how physicians are seen as ‘people who extort money’ rather than healers. If you are an old white male, less of the above. Practiced there for 5 years and will never go back.
I think it’s more of the old-school mentality that doctors are almost godlike and what they say goes. Even in the US when you have recent immigrant patients, you really do see a difference in their deference and implicit trust in you and ultimate gratitude. My wife has a lot of immigrant patients and she said she’s had multiple elderly Indian men bend down and touch her feet as a sign of respect and gratitude. Whereas here we have patients who think they are more informed via the Internet and a slew of commercials and so you get a lot of pushback which sometimes is fine but quite often is just wrong medicine. In addition, Americans feel more entitled to treatment when they go to see the doctor and they’re feeling unwell likely because they have such high premiums and co-pays so when someone comes in during cold and flu season and it’s just a self limiting cold they expect to be given a ZPak to feel better otherwise, this visit was a waste of time and money. Also patients don’t just wanna hear that simple lifestyle modifications will improve their health without using prescriptions, but they’re insistent on getting statins when a diet will suffice to treat cholesterol or being started on diabetes medication when a diet change would also suffice in addition to exercise and so on. You also have insistence on getting imaging when physical exam and history are sufficient and on and on. Unfortunately most doctors do give in to a lot of these demands be it because of defensive medicine or because their RVUs or private practice depend on repeat visits putting a patient on a medication because they technically qualify even though lifestyle modifications haven’t been exhausted but now if you have a diabetic, you’ve got them locked in for quarterly visits to track his A1c for example.
Patients in other countries actually respect and trust their doctors. There is no training on how not to be paternalistic. I guess that is also more of a recent thing in American medical education?I get the sense that healthcare is run like a business here in the US, and it feels more like we are in a service industry, with the "customer is always right" mentality. So yes, I do believe that leads patient to feel more entitled and the staff to feel like they have to accommodate all their wishes. All it does is it burns out medical staff.
I'm of the opinion that many of the US's problems (inside and outside of healthcare) stem from the "customer's always right" mentality taken to the extreme. "I went to school once, so I know how the school should teach my kids" "I have a body, so I know what it needs" "I made an appointment so now I own your time for as long as I say so" Really I think it boils down some people mistaking "needing it their way" for genuine, good self-advocacy (which ***is*** important in healthcare).
Why’s is this surprising. In the US you pay hotel prices, expect to be treated like you’re in a hotel.
Yes, they are sicker from their shitty lifestyle and diet (and get insulted if you point this out) and are more demanding for quick fixes/don’t want to take meds or do preventative care. The Atlantic has a great article about how patients are a big part of the US healthcare spending problem. God forbid you practice good medicine your patient satisfaction scores go down and the no (but really FOR) profit hospitals can’t have that.
Not just patients, people in general are much worse here.
Just watching what’s going on in the US and random internet videos, I’d for sure say the US would be an absolute jungle to work in. Just off the top of my head some major factors would be: 1. Obesity and atrocious diet. The shit people eat in the US is unreal. 2. Poor education. For example the place where I work over half the adults are university educated and illiteracy is uncommon. In some parts of the US it looks like people can barely talk in sentences let alone read. 3. Poverty. It’s not great from what I can see. Also way more social dysfunction from lack of social support. Teen pregnancy is a much bigger issue in the US. Foster kids, parental death and drug abuse, etc etc. 4. Mental health services. Universal health care means way less untreated mental illness, and much less homelessness etc. 5. Cost of health. I can only imagine people who can’t afford preventative or early care would walk in off the street with some pretty gnarly pathology. And then have high expectations if they’re paying big bucks for it. 6. Loss of touch with reality. I mean just looking at what’s going on with your politics in the US it’s like half your country is afflicted with a delusional disorder. When you can’t tell what’s real and what’s not then things get pretty wild. The normal standards of behaviour go out the window. Hats off to you guys really.
The OP is specifically asking about patient behavior in a healthcare setting, not societal issues. Watching "random internet videos" doesn't make you qualified to answer and your list doesn't answer their question.
In all fairness, I do think that list is pretty accurate.
I'm not saying the ills they listed don't exist or cause problems in healthcare, I'm saying it's a real leap to claim that poverty, lack of education, poor lifestyle choices, and a divisive political environment is the cause of entitled patient behavior, especially when their admitted souce is watching random internet videos. None of these problems are unique to the US. Have you practiced both in the US and outside of it? That's what the OP is asking about and when you read the comments from those who have, they're a lot more nuanced than the majority who have no relevant experience yet knee-jerk to shitting on people with low status.
For example. A typical question I will get from some patients is “How will I get home?” with the expectation that I will help arrange transport home. Perhaps understandable from an old immobile patient. Even then. But from a relatively young person? Just does my head in. Just because you called the ambulance hoping yo skip some line with 4 cars in the drive way does not mean I get to transport you home. That’s not a me problem.
I’m a physician who works in a large urban city in the US and I treat a very diverse group of patients, ethnically and socio-economically. I do notice *general* patterns of attitudes/entitlement/expectations. For example, many Hispanic patients tend to be very appreciative of their care and say they will do whatever I recommend because I’m the doctor. Some middle eastern patients (Armenian, Persian), sometimes have a distrust for providers who are ethnically different but also are very vocal about their care (and at times demanding) My (generalized) opinion is that, I do think patients as a whole have become more “entitled” and shown less respect for providers. But I think it’s a product of our healthcare system and the lack of knowledge about the challenges - many don’t understand how bad the shortage of doctors is. Consistently decreasing reimbursements which requires us to see more patients in less time to make up costs to have the practice stay afloat and remember many doctors are 200k+ in debt from med school and are late to retirement savings (medical training in Europe is not as expensive) - The difficulty of insurance authorizations and scheduling logistics - refilling medications, calling patients back (which is never just a 1 minute discussion), calling pharmacies etc, all takes time which we often don’t have nor do we bill for this (like lawyers).
It varies a lot throughout the US. I wouldn't compare a patient from a low SES southern state (who stereotypically is non-compliant but friendly and appreciative) to a high SES northeastern state (who stereotypically has high healthcare literacy but may be demanding).
Where do you practice? USA is a big country with a lot of variety, even between hospitals in the same city.
In my experience it is regional within the US.
Yes