Personal View: How (not) to be a good patient
Authors: Daniel K Sokol
Journal: BMJ (2004)

Last Saturday, as I leapt in the air, salmon-like, to head the winning goal for the local football team, a clumsy defender bashed his head against mine. The impact of his forehead created such a deep, unsightly dent over my right eye that the other players, visibly repulsed by the wound, called for an ambulance. When the ambulance finally arrived, several interminable minutes past the government's eight minute target, the two paramedics waltzed in, sprightly and cheerful, in their green and yellow overalls. I was bothered by their apparent indifference to my plight—the alarming possibility of death or of life as a vegetable—but I mustered the inner strength to answer their questions: “How did it happen?” “Where were you hit?” “Where does it hurt?” and so on. I was trolleyed into the ambulance and taken to the hospital. The ambulance did not howl on the way there, which angered me further. Was my potentially life threatening injury not serious enough to warrant the howler?


The good patient is the unsung hero of the clinic


In the emergency room a nurse asked me how I'd been injured, where I was at the time, where it hurt, and so on. She then left me in the middle of the room, still in my wheelchair and holding the now melted ice pack on my demolished forehead, for 20 minutes. Doctors and nurses walked past without so much as a glance. I felt totally abandoned. “What the fuck is going on?” I eventually exclaimed, desperate to catch somebody's attention. A sombre nurse emerged from a cubicle and told me not to swear. I apologised, blaming my foul mood on the injury. She pushed the wheelchair into the vacant cubicle and started a familiar interrogation: “How did it happen?” “Where were you hit?” “Where does it hurt?” and so on. I answered the questions as before. “The doctor's on his way,” she told me as she left.

It looked as though the doctor was going to take an even longer time to appear than the paramedics did. When I questioned the nurse about the delay, she replied, “He won't be a minute.” Ten minutes later there was still no sign of the doctor. As the pain grew worse I started whining. A young doctor eventually arrived, apologised profusely for the wait, and injected me with painkillers. He then asked me how I injured my head, where the impact occurred, where it hurt, and so on. Suppressing a mounting sense of frustration I answered the questions exactly as before, unable to understand the need for a fourth account of the incident. Throughout the whole ordeal I was undeniably grumpy, foul mouthed, and ill tempered. When I returned home that evening it dawned on me that being a patient—a good patient—must be terribly difficult.

People often discuss what makes a good or bad doctor. A good doctor, for example, must be knowledgeable, technically adept, compassionate, patient, kind, trustworthy, morally sound, and a great communicator. But how often do we hear of the good patient? Hardly ever. The good patient is the unsung hero of the clinic. There is a striking similarity between the virtues of the good doctor and those of the good patient. Good patients are at once compassionate towards fellow patients and overworked hospital staff, tolerant when awaiting their turn and answering oft repeated questions, kind when communicating with others, trustworthy when reporting facts or taking their medicine, and, above all, understanding of the limitations and fallibility of medicine. I failed in nearly all of these counts. Whereas the good doctor must exercise these virtues and qualities while under pressure from bickering patients, anxious relatives, and limited time, the good patient must apply them in times of physical or emotional pain.

As patients we should strive to emulate those who suffer with such noble deportment and deplore those who, like me, disregard the interests of others as soon as the going gets a little tough. Diderot, the 18th century French author, called poverty and disease “those two great exorcists.” In other words a person's true nature is revealed not when that person is eating grapes and sipping champagne in a marbled jacuzzi but when under the stress of misery and ill health. At such times all that remains is a person's very core, devoid of pretence and superficiality. The good patient, then, embodies the most genuine type of human goodness. My brief but dishonourable stint in hospital has convinced me that patients deserve as much praise and criticism for their behaviour as doctors and that the public should be educated on the proper conduct in the stressful environment of the hospital.