Good patient, bad patient, effective patient

Our culture expects "good" patients to passively follow the rules.

  • Doctors are the experts.
  • Patients must do what the doctor says.
  • Patients may ask questions, but never question a doctor’s advice.
  • Patients must fill all prescriptions and take them exactly as prescribed.
  • If a patient does not recover, we must have done something wrong.
  • Seeking unconventional treatment is discouraged unless a doctor recommends it.

At the same time, "good" patients are supposed to exercise, eat right (whatever that means), drink water, and lose weight, get enough sleep, take medicines, and submit to procedures.  This demand on sick patients is quite hypocritical given the epidemic of sedentary, overweight “healthy” people chowing down on fast food, chugging sugary drinks, skipping annual physical and recommended medical tests. I would bet money that chronically sick patients are no different than everyone else when it comes to these habits. I’m pretty sure it’s more likely that sick patients choose healthier lifestyles than the average person because they have no other choice.

When migraine patients don’t respond to treatment, it is assumed we are doing something wrong. We become "bad" patients.

  • We’re not taking our meds right.
  • We’re not treating symptoms aggressively enough.
  • We’re treating symptoms too aggressively.
  • We have bad habits that need to change.
  • We have emotional problems.
  • We really don’t want to get better.

Our choices can affect the success or failure of treatment, but that’s not the only explanation.

  • We may not be seeing the right kind of doctor.
  • Both doctor and patient may fail to recognize an important variable affecting progress.
  • There may be undiagnosed comorbid conditions complicating our progress.
  • Some conditions are inherently difficult to treat.

We may not be seen as "good" patients, but letting the doctor call all the shots is usually not very effective. We are the ones who live with migraine every day. No doctor can ever truly understand what it like to be us. That’s why we get to call the shots. We hire and consult with health care professionals because we value their expertise. We can just as easily hire another. The ability to collaborate with our doctors is essential to the best outcomes. Collaboration is a mutual respect for each other’s expertise – the doctor has specialized training and we have specialized experience. Both are needed for effective results.

I don’t know about you, but I need my doctors. A life without triptans, Botox, and Toradol injections would be quite miserable. Those require a doctor, but not everything I do requires my doctor. Frankly, sometimes we disagree. Sometimes I am a "bad" patient and tell him I plan to ignore his advice. On rare occasions, I bring studies to his attention and ask about procedures that are new to him. Even though these behaviors require active participation in my care, my approach is not aggressive. New ideas or disagreements are presented in a respectful way that will not challenge his expertise. Doctors have feelings, too. The last thing I want is to create an adversary out the very person whose help I need.

When it comes to managing migraine, sometimes it pays to be "good" -- to sit quietly and listen carefully. Then there are times to be "bad" -- such as directly challenging abusive or unethical behavior. Effective patients and doctors engage in assertive collaboration for the best approach.

Can you think of situations in which you have been a "good" or "bad" patient? What were the results? What (if anything) could you have done to be more effective?

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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