Are Americans Really the Worst Patients?

A recent article was published in the Atlantic about Americans being the worst patients.

Americans are part of a broken and dysfunctional healthcare system with exorbitant costs, a maelstrom of bureaucratic red tape, and insurance coverage that barely covers what most people need.

But are they contributing to this system by being such bad patients?

The article in the Atlantic seems to imply that this is the case. The unwillingness of Americans to comply with doctor’s orders, take responsibility for their own health and medications, and their inability to accept the inevitability of dying has led to exorbitant healthcare costs. It also mentioned the highly expensive, and often unnecessary and futile treatment demanded by Americans.

I remember my early forays into American medicine. I had started my residency training in an extremely busy University hospital in Philadelphia. As a new immigrant doctor, I remember thinking why do we do so much overtesting and overtreating here, especially at the end of life.

In addition, patients kept coming back without making any personal effort to improve on their own health. They again underwent repeat testing and procedures.

 I greatly admired the immense value placed on each individual human life but could not understand the aggressiveness of care, especially in futile circumstances. In contrast, there was and still is, so little emphasis on the prevention of diseases other than periodic cancer screenings and vaccinations. Patients that are non adherent to treatment still show up expecting you to fix them..only to have them bounce back again.

Also, the corporatization of healthcare has rendered the patient as a mere customer and all aberrant behavior has to be tolerated. Treating patients as customers makes it harder to decline demands for pain meds and unnecessary antibiotics. This has led to overtreatment of pain, and in no small way, to the current opioid crisis.

Doctors also don’t have enough allotted time to talk about lifestyle modifications. In this era of political correctness, addressing health issues such as obesity early on can be viewed as fat shaming.

The threat of lawsuits and the fear of bad patient reviews often influences decision making.

So how could we all be better patients?

An important step would be to rebuild the  doctor-patient relationship. We need to re establish trust in physicians as the leader of the healthcare team. Studies have shown that building trust and having a good patient doctor experience can go a long way in ensuring compliance, follow up, and producing better outcomes. Malpractice policies also have to be better addressed if full trust is to be regained.

Social disparities and healthcare inequities also play a big role in patients adherence to treatment and ability to make lifestyle modifications.

With obesity reaching epidemic proportions and being a root cause of many other costly and debilitating diseases, these are important considerations.

Government policies such as adequate and paid maternity/paternity leave and good maternal health and child care can also play a big role in giving families tools to improve their health right from the start. Hospital systems, along with physicians, can also do more to promote community initiatives that  focus on disease prevention.

So yes, I do agree that Americans probably are the worst patients. But, it is not all their fault.

In many ways, the system has failed them too.

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Anupama Verma MD

Anupama Verma is a board-certified nephrologist practicing for close to seventeen years in Green Bay, Wisconsin. She graduated from the University of Nigeria and subsequently moved briefly to England. She then moved to the United States where she did her residency in internal medicine at the University of Pennsylvania/ Presbyterian health system. She did her fellowship in Nephrology at Lankenau Hospital in Philadelphia. She has lived and observed the practice of medicine on four continents and thus has unique insights into global healthcare. In addition, she teaches medical students and serves on the pharmaceutical and therapeutics committee at Bellin hospital. She believes strongly in preventive medicine and medical narratives to bring about change and healing. She is a patient and physician advocate and has contributed articles to KevinMD and Doximity among others. She is on Twitter and instagram @anuvmd. 

  4 comments for “Are Americans Really the Worst Patients?

  1. Kurt
    July 3, 2019 at 4:21 pm

    I’ve espoused this for years. Nothing is going to change until people are held accountable for their lousy health behaviors period. Getting there is the problem. Perhaps deeply discounted premiums for good behaviors but I don’t know what the hell to do with public aid.

  2. George Voigtlander
    July 1, 2019 at 8:02 am

    Oops, for the younger readers, Mike was a popular nationally syndicated Chicago columnist. He was noted for pointing out American foibles with wit and his own unique style.

  3. George Voigtlander
    July 1, 2019 at 7:57 am

    Almost 40 years ago Mike Royko said the same thing about American patients. In that column he brought up the same points of not accepting lifestyle changes and not accepting responsibility for their health. Things have not improved since then. He did not suggest DPC. Probably because doctors and patients had more autonomy then, and healthcare was a calling not an industry.

  4. Steve O'
    July 1, 2019 at 7:55 am

    You have unearthed the culture of the Eternal High School. We need a Dante to write about the travels through this Inferno.
    In the world of Friendly Fascism, one never exercises the power of command; one exercises the power to snitch – to covertly tell the Authorities about the malfeasance of others. Press Gainey is an evil, eager conduit of Snitch’n’Bitch American society.
    Everyone wishes to be on the Jury where these complaints are ratiocinated. It is hard to find an American humble enough to realize there is very little, if anything, about which (s)he has any competence, not to mention expertise. All are eager to play the jury, for they think that they think. In truth, each distills his or her own biases, and metes them out on the selected wrongdoer, drop by drop. If the name is unfamiliar to you, please look up the story of Richard Jewell.
    We will endure any measure of fascism for the joy of feeding our own ressentiment, “a sense of hostility directed at that which one identifies as the cause of one’s frustration.” That is why actual high school students shoot up their schools and kill their fellow sufferers in an absurdly futile outburst of wrath. Schools, churches and workplaces get shot up every week or so. I’m surprised that clinics and hospitals have so far been somewhat free of these outbursts.
    What’s the problem with American Patients? It’s hard enough just to breathe in this type of society. We venerate hucksters and psychopaths and become enraged at the truth-tellers; the diabetic who eats cream pies and goes on dialysis in a few years. His annoying nephrologist tells him the truth – and who wants to listen to that Puritan drivel? a $50 bottle of Magic Kidney Oil will solve the problem. Get it?

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