How to be an Authentic Doctor #25: Don’t Collect Monkeys


We have all heard about trying to get the “monkey off your back”. It is used in sports a lot as an overdone cliché when a guy can’t win a championship. In medicine, we need to investigate this phrase a little more closely because it has an important meaning. The “monkeys” I am talking about with patients are actually issues or problems. Patients come into our office with them all the time. They don’t have just one of them either. Many times they have a barrel of monkeys and they want the physician to take them. Here is a word of advice: do no become their zookeeper.

You may not always see these monkeys because when a patient arrives, he or she has the monkeys well hidden. Other patients in the waiting room hardly notice. The front staff is usually oblivious of them. Your nurse, however, usually gets a whiff of them. She senses that there are monkeys about. By the time you enter the room, however, the monkeys are all over the place and you realize that the place is a menagerie. What is sad and amazing is that these patients live with these monkeys all the time. They feed them. They take care of them. Now, since you are the doctor, they want to get rid of them and hand them over you.  Don’t take them.

It starts with a list. Complaints of dizziness, fatigue, or headaches are just little monkeys that got the patient to come in. Pretty soon the big monkeys come out. You may know them as depression, situational anxiety, fibromyalgia, or polysubstance abuse. There are a lot more monkeys I could name but does it really make a difference. You get the point.  For some reason the patient thinks that you deserve their monkeys since they don’t want to take care of them anymore. They are tired of it. Their monkeys weigh them down and since they don’t want to deal with the issues themselves they are kind enough to let you do it.

I want to be the first to say that I got enough monkeys of my own. I’ll admit it and also go on to say that I sure as heck don’t need any more. It took me awhile in private practice to realize that each time I left a patient’s room I had one, two or three monkeys on my back. The patients would say things like, “I want you to get me to quit smoking” or “I am overweight and I want YOU to address that”. Other bombshells of relationship problems, run-ins with the law or problems with money got laid on my back. These monkeys were all over me by the end of the day. I was becoming the Quasimodo of Medicine. Sure the patient felt better but I was burning out feeding all the monkeys they left with me.

My answer to this quandary is to turn the tables on the patients. You must make them take responsibility for their own monkeys. They have to kill the damn things before they make a mess everywhere. Give them assignments to fulfill. Make them jump productive hurdles that will get them to the right place and without a monkey in sight. They need to show some accountability to you because the next time they come in you will ask them if they followed through. If they say no, then you spend your time putting those monkeys back on their shoulders and you walk out monkey-free. That is how you survive.  They either get rid of their own monkeys (or at least show some effort trying to) or they keep them home.  In other words, just like at the zoo, don’t feed the animals!

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  7 comments for “How to be an Authentic Doctor #25: Don’t Collect Monkeys

  1. Bridget Reidy MD
    August 3, 2014 at 9:56 am

    One good way I got my patients’ weight monkey off my back is by asking them what THEY think they would have to do to lose weight. The answer invariably started with something easy I would be surprised they weren’t doing if it were only that easy, and the first two words were almost invariably “eat more….”, and occasionally exercise more. So you just name their monkey so they can see it, and you’re still helping them without acquiring it. There’s no reason we shouldn’t use common sense and science to help people blinded by our culture’s myths, and it doesn’t take long.
    Then I tell them that the fact that weight loss involves eating less is so counter cultural that it would take me a twenty minute visit devoted to that alone to show them all the ways it contradicts what they think, and probably a series of such visits to change their subconscious thoughts enough to put it into practice. Very few sign up and they deserve to hear it. The ones who go on to tell me all the things they eat, (invariably without mention of quantity) I can quickly silence at that point, and they never dump that stuff on me again.

  2. Dave Fitzpatrick MD
    July 31, 2014 at 9:32 pm

    Balant training. Dr. Michael Balant. It works.
    Love, Dave

  3. politovski
    July 31, 2014 at 9:07 am

    Straight from the House of God, House Law #4, The patient is the one with the disease.

  4. Sir Lance-a-lot
    July 30, 2014 at 10:32 pm

    “Everybody who read the Jungle Book knows that
    Riki Tiki Tavi is a mongoose who kills snakes.
    When I was a young man, I was led to believe that there were organizations to kill my snakes for me,
    i.e: the Church
    i.e.: the Government
    i.e.: School,
    But when I got a little older, I learned I had to kill them myself.”

    — Donovan, “Riki Tiki Tavi Mongoose is Gone,” about 1970

    • Pat
      July 31, 2014 at 12:19 am

      “Okay then, well I just sell propane, and propane accessories, so I think I’ll go do that.”
      — Hank Hill

  5. William Bodenheimer
    July 30, 2014 at 4:29 pm

    What a great article. I could not agree more. I learned long ago that patients’ problems are just that–their problems. I used to get myself all upset over my patients’ problems and their unwillingness to follow my instructions and take responsibility for themselves. Now I just let it go. Remember, we live in America the Land of No Personal Responsibility so your pt’s will want you to take responsibility for them. Just refuse to do so and you will be a much happier physician.

  6. Dr Mom
    July 30, 2014 at 8:25 am

    “Not my circus. Not my monkeys.” – old Polish proverb.

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