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Good patient, bad patient, effective patient

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?

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.


  • Kristy
    3 years ago

    I had been waiting for 6 months for my appt after my referral final went through for a new neuro. My previous neuro closed practice and then I lost my job, insurance, etc. While waiting for disability, I was temporarily on state insurance. I had waited now nearly a year to see someone finally to get a treatment plan in place, however I had so much anxiety and hope I was not prepared for any let downs. The dr. barely examined me asked a few questions about what I was taking and previously took. Then said there is nothing I can do for you, you have tried everything, Botox only thing that will help and your insurance won’t pay for. So I just burst into tears, I wasn’t ready for this, I needed support and understanding, I just sat there confused like I was given a death sentence. I said so what my PCP is supposed to just keep me on my current meds? She said yes. I didn’t get it. She shuffled me out of there so fast I has no time to even know how to respond. I was checking out crying….ridiculous! I high expectations, that were not met and should of been. So I am now waiting again 18 months now, appt this Oct. But in the meantime I did get approved for disability and will receive Medicare benefits next year. So all in all I learned my lesson, don’t settle, don’t give up, and take someone with you to your appointments to help process the information and be an advocate on your behalf.

  • E.Nye
    3 years ago

    “We hire and consult with health care professionals because we value their expertise. We can just as easily hire another.”

    This. This is THE BEST piece of advice ever. Whether you pay premiums directly or they are part of your benefits package, you are paying the insurance that pays them (hopefully you’re not paying straight OOP, because that is awful and expensive). We are the consumers here, and just like anything else, if you don’t like something, take your business elsewhere. That’s not to say fire your doc for a disagreement, misunderstanding, or difference of opinion; if you feel unheard, ignored, belittled, or (worse) that you are “making it up,” then leave.

    Side note– you are entitled to a ONE TIME copy of your medical records upon request. Most offices won’t charge you for them, but by law, they totally could… with the exception of a one time request. I believe that they can charge after a certain number of pages (I think it’s 50), but up to that point there should NOT be a charge.

  • chronicity
    3 years ago

    It’s a great idea to keep a copy of your own medical records. But actually laws about whether and how much providers can charge for medical records and under what circumstances very by state. For example where I live providers can and sometimes will charge for even the first request. At the place where I get the majority of my treatment (A large, prestigious & famous, non-profit medical center) charges every request at a fairly high rate (73¢ Per page for the first 50-100, less after that IIRC) including the first request made. If you’re lucky and nice to them while requesting the record the women who process the request may send them to you for free, but there are no guarantees, and they do not have the leeway to do that for large numbers of peaches peaches.

  • Elliegal
    3 years ago

    I have had many situations where, from the Doctor’s point of view, I was a bad patient. In almost each instance, I followed my gut instinct and dumped the doctor, moved on to a different one in the same specialty. I’m very glad I did.
    The only time I didn’t follow my gut instinct and make a fuss, was a pre-op visit by a surgeon when I was 19. Then I should have made a big fuss. I learned my lesson. A breast exam is NOT part of a tonsillectomy.
    I have learned to keep an open mind and give new treatments for my migraine a short chance, maybe a couple of months. If there is no noticeable improvement, move on the the next option. I wasted a year feeling horrible on Topamax, refusing to increase my RX to progressively higher dosages recommended by my neuro. I actually felt so much better after stopping, that I never started the next “new med”. Every “expert” I try wants to add something to my already overloaded med schedule, but not one wants to take anything away. Now I have a new neuro and we’re trying beta blockers to some improvement.
    Bottom line: Be an advocate for yourself. Only you know how you feel. Listen to your body and find a Dr that will listen to you.

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