Me first! behavior: why health care turns patients from nice to nasty

by Dr. Trina E. Dorrah

What is Me first! behavior?

Recently, I read an article in USA Today by Christopher Elliott entitled, “Me first! Why is selfish behavior on the rise?” When I saw the title, I immediately thought, this article must be about health care. In fact, my friend and I were just discussing the fact that since we initially became physicians 10+ years ago, we’ve seen a definite increase in selfish behavior among patients and families. Who’s to blame? The health care industry, whose increasing prices and cost-shifting strategies frustrate so many? Doctors and health care professionals, who have lost some of the public’s respect and trust over the years? Or do we blame the patients themselves, and attribute it to unrealistic expectations fueled by the increased focus on patient engagement?

Before you think, “She’s just a doctor who cannot handle having an empowered patient,” let me stop you right there. In addition to being a physician, I am a strong advocate for improving the patient experience. When I talk about selfish, Me first! behavior, I’m not talking about the knowledgeable patient who plays an active role in his or her health. Nor am I talking about patients who prefer to have a collaborative relationship with their doctor. Most physicians agree – these are the patients we love taking care of because they are motivated to work with us to improve their health.

Me first! behavior describes patients who act as if their illness takes precedence above anything else their doctor is doing or any other patient their doctor is seeing. Patients or families who display Me first! behavior are often frustrated, and as this frustration grows, it turns to anger. Unfortunately, the doctors and medical staff are on the receiving end of this anger. This leads to a situation where the very people who have dedicated their lives to helping patients and families through illness are the ones being yelled at and disrespected.

How did we get to this point, and what can be done to correct it? Interestingly, Christopher Elliott’s article was about selfishness among airline travelers, but in my opinion, his observations perfectly explain why health care has seen a similar increase in Me first! behavior.

Why the increase in Me first! behavior?

1.     Selfish behavior flares during times of high anxiety. When people are stressed, they lapse into survival mode, and they primarily focus on themselves.

o   Being ill, especially if you are hospitalized, is one of the most stressful experiences in life. In addition to their normal stressors, patients and families are also dealing with the added stress and uncertainty of illness. This increased stress causes many people to revert to survival mode, where they are incapable of caring about anyone or anything other than themselves. As one of my attending physicians told me in residency, “Trina, you must always remember - the people we care for are not at their best.”

2.     The industry adds stress through surprise fees and unanticipated hassles.

o   As employers decrease their health insurance contributions, patients are being asked to pay a higher portion of the cost. In addition, many clinics and hospitals have become more aggressive in terms of bill collection, and they require higher payments up front. Most patients are not used to this model of cost-sharing, so being asked to increase the amount for which they are financially responsible is a huge stressor.

3.     Customers are outside of their comfort zones.

o   No matter how much patients consult the Internet, navigating through the health care system is difficult. Delays, medical complexity, and communication barriers are only some of the factors that make health care frustrating. Even when patients are engaged in their care, the doctor is still the medical expert. In fact, patients educate themselves not to annoy their provider, but in part to ease the anxiety that comes from being in an unfamiliar situation.

4.     Customers often have unrealistic expectations.

o   When patients enter our health care system, they do not just compare us to other health care organizations. Patients compare us to any other business they’ve interacted with. Our society has evolved, and customers increasingly have the ability to make their opinion known. However, health care is different in some very important ways from other service industries. For example, in the business world, the customer is always right. In health care, the patient cannot always be right, because what the patient wants may lead to illness, injury, or even death. It is up to the medical community to educate our patients and help them set realistic expectations.

Now that we know the causes, what can health care providers do to prevent patients from engaging in Me first! behavior?

What can health care providers do to prevent Me first! behavior?

1.     Communicate – more than anything, I believe frustration arises from a lack of knowledge and understanding. When patients feel like they are not listened to or communicated with, they become defensive. They feel like they have to protect themselves above all others, and they slip into the destructive patterns of Me first! behavior. Through communication, patients feel that they know what is going on, and their anxiety is decreased. One easy way for doctors to improve communication is to end the visit by asking patients for questions. This gives patients the opportunity to clarify anything they do not understand.

2.     Engage in collaborate relationships – when patients feel like their health care provider values their opinion, they have a better patient experience. Even though the doctor has the medical expertise, patient input is vital to reaching the collective goal of caring for that patient. One way to improve collaboration is to ask patients their one or two top concerns that they want to addressed, then have the doctor address those concerns that matter most to the patient before ending the visit.

3.     Educate our patients – patients need to know what to expect so they can have realistic expectations. A great deal of stress and frustration can be averted when patients know, and education helps patients to better prepare for their health care experience. One easy way to improve education is to engage patients with technology. Numerous medical apps and websites exist that can be used to increase patients’ education and understanding about their illness.

4.     Show them we care – in the end, being compassionate and showing patients we care goes a long way toward creating a positive patient experience. When patients know their doctors truly care about them, they are much more willing to deal with the inevitable stress that illness brings. One of the best ways to demonstrate empathy is to simply stop and listen. Ask patients how they are doing. Find out what’s going on in their lives. Patients know their doctors are busy and pressed for time, but when you take an extra moment to show you care, you’ll be surprised by how quickly Me first! behavior disappears.

Dr. Trina E. Dorrah is an internal medicine physician/hospitalist and the author of Physician's Guide to Surviving CGCAHPS & HCAHPS. She can be reached on Twitter @drtrinadorrah or through her website www.drtrinadorrah.com.