I recently underwent a relatively minor surgical procedure that went smoothly and without complications. It was performed by an experienced and kind physician who came highly recommended by a colleague. In the recovery room, a nurse woke me, helped me get dressed swiftly for a prompt discharge, and supported me to the sitting area—still groggy from anesthesia—where my parents were waiting to take me home. I was told that the surgery had gone well, as expected, and that the physician had already spoken with my parents.
I was relieved to hear the good news, but I wished I had been able to speak with the physician myself. I had a couple of specific questions about what may have been observed during the procedure vis a vis what was seen on an ultrasound. The next day, I called the front desk to ask if I could speak directly with the physician. The person I spoke with informed me that the physician had already spoken to my parents after the surgery. The tone—and the implicit message—felt like, “What more do you want?” I explained that I was the patient, and that my parents did not, and could not, have asked the questions I had.
The following day, I received a missed voicemail from the physician reiterating that the procedure had gone well and advising me to await the biopsy results. I knew I was privileged to receive that call, and I was grateful. Still, I had two specific questions that remained unanswered, so I sent them through the patient portal. A day later, the physician called me back and answered my questions. Again, I sensed this was a privilege and felt grateful. Overall, my experience left me feeling I was perceived as a “high-maintenance” patient.
Not long after, I came across an email thread on a physician platform of which I am a member. Someone had raised what they described as unreasonable expectations from patients who call asking to speak directly with their physicians. Many seemed to feel that patients’ expectations to reach physicians by phone were unrealistic while a couple of people suggested asking patient to scheduling an appointment for these questions. I could see the perspectives of my colleagues. Suddenly, it clicked why my own attempt to reach a physician had felt burdensome. This is the modus operandi of our healthcare system.
Within current physician workflows, patients typically get one shot—often a brief one—at interacting with their physician about a specific issue. Any follow-up questions are expected to be addressed through another visit. Whether that visit can happen, and whether it will occur in a timeframe that actually meets the patient’s needs, depends entirely on provider availability rather than patient necessity.
The healthcare industry has its foundations firmly planted in capitalism. Our service delivery models are designed first and foremost for profit. This orientation is so deeply ingrained that the unique role physicians play in the care of human lives—and patients’ need for physical and emotional connection with their caregivers—is often viewed as a nuisance or a disruption to the workflow of busy providers. Despite extensive research showing that patient-physician shared understanding of medical recommendations is no better than a coin toss—meaning many patients either do not fully understand or soon forget critical information with direct implications for safety, medication adherence, and health outcomes—physicians are frequently frustrated when patients ask follow-up questions after an initial discussion.
Even more troubling is that most patients have come to accept this as normal. They are conditioned to feel demanding, or even inappropriate, for wanting to speak with their physicians. Yes, there are some patients who are demanding and/or even inappropriate with their asks and these patient need firm redirection but the majority of patients often have reasonable and critical questions that often don’t get asked because they are made to feel like an imposition on a system that is set up for quick throughput.
The reality is patients have a right to have their medical questions answered. Period. The widespread practice that makes patients feel unreasonable for asking to speak with their providers is a cultural norm we have accepted without examining its morality or considering the patient’s perspective. This norm is not unlike our collective resignation to the idea that the average patient-physician face-to-face encounter lasts only fifteen minutes, regardless of the complexity of the patient’s condition.
Businesses—including healthcare—will always feel pressure to prioritize profit over people. Physicians who speak out against this reality are neither naïve idealists nor opposed to financial sustainability. Rather, they are part of a small but necessary group challenging the unexamined conformity of a healthcare delivery model that routinely marginalizes the needs of the very people we have vowed to serve.