How broadly is your doctor smiling?


Dr. Craig Hildreth is a medical oncologist who writes a regular blog about issues related to the management of patients with cancer on the CancerNetwork web site. … and no the doctor isn’t smiling because of how much money s/he is about to make from seeing you!

We glance at Dr. Hildreth’s blog posts on a regular basis because every so often they provide some real insight for patients into how physicians need to be able to deal with the challenges that patients can present. In his most recent blog post, Dr. Hildreth addresses the issues surrounding “Communicating with the troubled patient.”

As a patient with a long-term chronic disorder (albeit not a prostate cancer patient), your sitemaster has always considered it one of his responsibilities to be “interesting” as opposed to “challenging” or “troubled” when dealing with his physicians. This often allows him to raise questions in a non-confrontational manner when he is looking for insight beyond the expectations of his doctors.

In Dr. Hildreth’s article he concludes by telling his fellow physicians about how walking into the exam room to see patients with a smile on their faces “means you, not the troubled patient, have just set the tone for the visit.” For patients it may be worth bearing in mind that one will get the best out of one’s physicians if, indeed, they can feel they are setting the tone for each visit with you … but if you learn to play your cards right, you may actually be the one who is able to manage the tone!

While we understand that there are times when some polite confrontation of a physician by his or her patient may be necessary and valuable, it’s not something that a patient wants to get a reputation for. Why? Because it may lead to you being seen as “troubled” or difficult” by the very doctor who you want to see you as “inquisitive, engaged, and deserving all the help that s/he can provide.” The wise patient (with prostate cancer or any other serious disorder) will think hard about how to make his doctors see him (or her) in the latter light!

4 Responses

  1. Excellent insight and very good advice. … Doctors are no different than us; we do not like to work with hard cases either.

    God Bless

  2. Well, that’s just wonderful! Now the patient has to appear “untroubled,” or else be labeled as a “type” or disgruntled or perhaps “potentially litigious”! So good luck finding a dependable medical practitioner who is truly your “ally”!

  3. Dear Natron:

    I’m not at all sure what you point is. The situation you (and Dr. Hildreth) describe has been true from the days of Galen (c. 200 AD), who, among other things in his very extensive medical writings, carefully described exactly the sorts of patients you have just described and noted that they could be difficult to work with as a physician. You might like to note kEN’s comment immediately above.

  4. I scanned this article on Medscape too — it raises the fine line patients must tread if they are truly to be their own best advocates.

    Doctors should not be placed on pedestals; their advice and knowledge can and, in many instances, should be questioned. In the prostate cancer world, this is particularly true since there are too many conflicts of interest. It may be equally true in many other areas of clinical practice too, but I don’t have that knowledge.

    The “difficult” patient can also be the patient who drills down on his options, asks for evidential support,and explores alternatives that may not be provided by the practitioner he is facing. All this can take more time than the doctor allotted — and that makes this patient even more “difficult”.

    I guess the key is to ask all these questions with a smile on your face. Certainly our Sitemaster is a knowledgeable consumer, and likely very well informed about his own condition. How do we go about representing ourselves well without being considered the difficult patient?

    Perhaps one answer is to select a doctor who we feel is on our wavelength. That has worked for me, since I cannot always guarantee a smile. I am interested to hear others’ responses.

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