DrG's Medisense Feature Article

Getting the Most Out of Your Doctor:  How Nice Is Best? 
December 2011
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I’ve written much about how to get the most out of your doctor.  I’ve often suggested that you advocate for yourself in a civilized manner, recognizing that you are not the doctor’s only patient and he/she is human, under time, financial and regulatory constraints.  Should you construe that to mean that you should always be “nice”?  Is that the best way to get good medical care? 

A recent commentary in the Journal of the American Medical Association concludes that “nice patients and families receive a level of care that is perhaps at times well above the professional standard.”  The authors consider the meaning of “nice,” recognizing that different physicians perceive different patterns of behavior as “nice.”  They admit that it is hard for any human to be professional enough to behave exactly the same towards patients he/she likes and those who are detested. 

Medical care, rarely a simple and straightforward endeavor, requires thought, effort, consideration and time.  Choosing to invest those limited resources equally into absolutely every patient, “nice” or obnoxious, can be draining.  So doctors often marginalize the un-nice, or even treat them poorly. 

I have psychiatrically difficult patients who have irritated other doctors so much that the medical care verged on malpractice.  This lousy “care” is also often rudely delivered to patients who really have very little control over their behavior. 

On the other side of the story, the “nice” patient, personal friends and colleagues of the doctor and “very important persons” often get more attention, testing and treatment.  Is it fair?  No.  Is it best?  Not necessarily.

What if a doctor’s being extra nice to a favored patient means that the patient gets a marginally appropriate procedure which causes a harmful outcome?  Or receives too many antibiotics, causing drug resistance that could make a subsequent infection very dangerous?  In that case, over-doing it means worse medical care. 

Can you be too “nice”?  By being “nice,” do you sabotage your own care by going along with the doctor, without questioning?  Do you choose to not interrupt, thereby failing to mention a possibly contradictory symptom?  Passivity and suppressed dissention, in the interest of being nice isn’t necessarily in your best interest.

Sometimes polite assertiveness produces better results, as long as assertiveness doesn’t assume the face of counterproductive hostility.   I favor productive, polite and civilized questioning and involvement in decision-making, with a smile that looks more sincere than Jack Nicholson’s Joker’s.