The Older the Doctor, the Higher the Patient Mortality Rate, Study Finds (arstechnica.com) 136
An anonymous reader quotes a report from Ars Technica: The age of your doctor may impact the quality of the care you receive -- and even cut your chances of survival -- researchers report in the British Medical Journal. Harvard researchers looked over data on more than 700,000 hospital admissions of elderly patients cared for by nearly 19,000 physicians between 2011 and 2014. They found that mortality rates crept up in step with physician age. Patients with doctors under the age of 40 had a 30-day mortality rate of 10.8 percent. With doctors aged 40 to 49, mortality rates inched up to 11.1 percent, then to 11.3 percent with doctors 50 to 59, and 12.1 percent with doctors aged 60 or above. The stats are adjusted for a variety of variables, such as hospital mortality rates and severity of patients' illnesses. All the patients were aged 65 or older and on Medicare. Though the age-related mortality trend was significant overall, it broke down when researchers sorted doctors by caseloads. Older doctors who saw high volumes of patients didn't see their patients' mortality rates increase.
Flawed study (Score:5, Insightful)
How do we know that older patients don't just like going to older doctors?
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It does seem likely. I'd guess they mostly have been seeing the same doctor for many, many years, and have no interest in changing.
Did they correlate the doctor's age with the patient's age? Do older doctors tend to see more older (and thus more likely to die soon) patients?
Re:Flawed study (Score:5, Interesting)
Summary says they were all "elderly patients", so the factor changing is the age of the doctor.
I think the busy doctor == good doctor correlation holds true as well, was certainly the case for mine. Might be that the good ones are kept busy, but I suspect as much that the work keeps their minds sharp.
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Private sector or military production lines in the 1950-80's that just had to make a product with no consideration for the workers health.
Decades later an older Dr in that community has to run all the tests and gets all the bad results that finally gets noticed by national researchers.
Lots of poor, sick workers got exposed to all kinds of issues and that generational result is now showing
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Numbers are probably too big for this theory; 700,000 cases.
Re:Flawed study (Score:4, Interesting)
"Elderly patients" covers a lot of territory. A 60 year old and a 90 year old are both elderly, but do not have the same life expectancy. And the 90 year old has likely been seeing the same doctor for years longer, so that doctor is likely older.
If they didn't ask the question, it's not a very useful study.
Re:Flawed study (Score:4, Interesting)
Yeah, I agree, except that the life expectancy for people over 65 going to the doctor is probably more consistent.
Plus, it's about the weight of numbers; if the mortality rate for all patients that attend hospital A was 10% and hospital B was 15%, does it matter how old you are when you're picking between those two hospitals? Assuming the same catchment area, hence the choice.
Attending hospital tends to already select for people with a higher than average mortality rate.
Besides, the authors understand there's not enough information to act on, but it's enough to suggest that the area be studied at greater depth to see if there's a case for adjusting how continuing education is managed.
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The mortality rate for everyone is 100%.
Re:Flawed study (Score:5, Informative)
If they didn't ask the question, it's not a very useful study.
They adjusted for patient age. This is explained in the actual paper [bmj.com]. They also adjusted for gender, ethnicity, household income, day of week of admission, etc.
They also considered many characteristics of the doctor besides age, including gender, medical school attended, etc.
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Yet to read the study ( I intend to). And no, i don't consider myself to be part of the "older" physician group ;-)
The problem with all these large sample studies is the confounding factors and the quality of the data.
Sure, the said the "corrected for" but did they correct enough for all??? We'll never know. Not until randomized controlled studies are performed, and they'll never will.
So there is 22.000 patients entered in the analysis. with only 5% in the interesting group, where the "magic" happens leadin
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It's an observational study. MOST observational study conclusions end up failing to be reproduced in prospective studies - for reasons you point out.
The end point was 30 day mortality. Readmit rates were unchanged. The latter is typically a better discriminator for 'bad care' - if the patient has to come back to the hospital in a month for the same reason, you can argue that you should have done something different (doesn't always work, but it seems to be a valid generality).
30 day mortality suggests (bu
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An older doctor might serve a poor area with a lot of complex industrial conditions that now present in very, very sick older groups of workers.
Been one of the few local Dr they have to see a larger amount of very complex conditions.
A younger Dr moving into a nice a
Re:Flawed study (Score:5, Insightful)
A young Dr can also be very selective in the areas they want to practice ... An older doctor might serve a poor area
The study compared doctors working at the same hospital, and adjusted for patient household income.
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Doctors on call at a central hospital who see a patient might see a lot of different patients.
So follow the trail back up into the community to the Dr the person saw for years of longer.
Is that Dr young or old....
Some nations fly lots of different patients in at night as their pilots have real skills and are allowed to.
That time difference could make a lot of difference.,br> All kinds of factors can add up to strange numbers in
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For some reason, there are always lots of idiots who think that researchers no nothing about statistics, and never think to correct or account for obvious factors. Slashdot is practically the poster boy for the Dunning-Kruger effect.
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That is because they usually don't...
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Of course researchers know about statistics, but they also want to publish successful results.
Even honest researchers will try to make their papers as impressive as possible, because their funding depend on it, and a simple correlation is better than nothing. Failures, even though they may be as valuable as successes don't publish well. These papers may be picked up by less rigorous journalists and presented with the conclusion the original researchers carefully avoided.
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Yes, they are more experienced and often more confident, but they can also be less well versed in more modern treatments and techniques - continuous professional development isnt as intense and all covering as a doctors initial training, so the younger the doctor is, the more recent their core training will be...
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People and their complex conditions grow with their Dr and finally the a large amount of people on average over decades need a lot mores tests and expensive treatment on average.
Their existing older Dr they know for years looks after them and is their gateway to specialists and hospitals.
Why waste time looking at a Dr age. Look at
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I think one thing that's really hard to test is if a different doctor, whether younger, from a different med school or a different ethnicity, would have done any better. This is because, by the time you know you want to check, the patient is already dead. And no two people are exactly alike, so, ethics aside, you can't run blind tests.
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Put all that back together and most smart nations can find their skilled dr's, best hospitals and experts.
Peer review looking over lab results, surgery done and the track record per doctor.
Average it out over every teaching hospital in a nation and all the once hidden results really stand out.
Many nations fear such results as the very average doctors get found out.
The othe
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No, these patients were not seen by 'their' doctors. They were seen by a hospitalist who probably has never seen the patient before. The US is moving to the same model as a number of other countries with a distinct separation between inpatient and outpatient sectors.
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From the report:
Our findings might just as likely reflect cohort effects rather than declining clinical performance associated with greater age, which has important implications for interpretation of our findings.
Science journalism strikes again.
Re: Flawed study (Score:2)
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President James Garfield was killed by older, experienced doctors, who ignored the "wash your hands before poking at wounds" nonsense espoused by the younger generation.
It seems unlikely that any doctor attending him is still alive to influence this study today.
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Re:Flawed study (Score:5, Insightful)
How do we know that older patients don't just like going to older doctors?
RTFS?
"700,000 hospital admissions of elderly patients"
My personal guess is that older doctors might be a little better at weighing quality of life against longevity, while younger doctors might be following the book more, prolonging life no matter what the physical/mental/monetary cost to the patient is. That would explain why older doctors with a high workload didn't show the same drop in longevity - they won't have time to get to know each patients as well.
I know that when my time draws near, I hope I find a doctor that can help me have a good quality of life for my last few days or weeks, even if it's shorter. And preferably without bankrupting those I leave behind on expensive treatments that can only prolong agony.
So I'll likely try to find an older doctor with empathy.
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Doctor burnout (Score:2)
Though the age-related mortality trend was significant overall, it broke down when researchers sorted doctors by caseloads. Older doctors who saw high volumes of patients didn't see their patients' mortality rates increase.
My guess is that older doctors with a larger caseload is a sign that they enjoy their job and are staying current in medicine and engaged with their patients. Those with a lower caseload are burned out and getting ready to retire.
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My guess is that older doctors with a larger caseload is a sign that they enjoy their job and are staying current in medicine and engaged with their patients. Those with a lower caseload are burned out and getting ready to retire.
That's your guess. Mine is that older doctors with a larger caseload have less time to talk to each patient, and will more likely go for the standard life-prolonging treatments by default.
We could both be right or both be wrong, of course.
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preferably without bankrupting those I leave behind
Seriously, what kind of health care is that? Your government milks you for all your worth to go kill people in another country and look after their own with free medical. You guys are getting raped!!!
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From my experience/not scientific.
Older Doctors (like older people in any profession) will use their experience increasingly over time. While younger doctors, will supplement their lack of experience with learning the new methods.
The younger doctors today, are far more willing to query their Electronic Health Records and see the full patient history, trust the Drug to Drug and Allergy alerts. Do wider analysis on what others may have done for this particular case. While the older doctor, will just complain
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In my observation, younger doctors tend to be full of education, but empty of experience, and their primary means of making mistakes is being too by-the book; also, they tend not to listen to the patient. Older doctors are more likely to treat the patient rather than treating the test results; after all the object is to get you symptom-free, not to make the tests look pretty.
I would guess that a lot of older patients have come to recognise this and go to older doctors, so naturally the mortality rate is hig
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How do we know that older patients don't just like going to older doctors?
This was my first thought. In my area we have a lot of retirees, and the doctors are older too. When they were young they treated gunshot wounds and drug overdoses in the big city. Now they're up here in the mountains replacing hips, transplanting kidneys and treating hiker falls.
Re:Flawed study (Score:5, Informative)
How do we know that older patients don't just like going to older doctors?
The patients were unlikely to be choosing their doctor in this study.
The doctors used for this study were hospitalists. Hospitalists care for patients admitted to the hospital.
Your regular primary care doctor is unlikely to be a hospitalist (although some hospitalists do have regular clinic days) because you are not getting admitted to the hospital for a sore throat or broken arm.
Hospitalists treat very sick people, and in the hospital where I worked, they were considered to be higher-skill doctors then your regular doctor.
The study used the records of hospitalists because generally speaking, the patient does not get a chance to choose their hospitalist, and the study wanted to avoid that factor. Also because hospitalists treat admitted patients, they are dealing with people who are far more likely die without treatment, so that makes the numbers interesting.
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But does the hospitalist get to choose the patient? I'm not familiar with hospital procedures so can't say. The original paper addresses it with:
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I would go a little stronger than that.
Older patients DO prefer older doctors.
However it is MUCH more obvious even that that.
Patients WITH MORE SERIOUS ISSUES tend to be allocated to MORE EXPERIENCED (ie: odler) DOCTORS.
And, more serious issues tend to have higher mortality rates.
Of course, they 'adjust for severity of illness', however that is impossible to do, as not all examples of a single illness have the same risks, and the more severe cases end up with the older doctors.
A class case of correlation no
Re:Flawed study (Score:5, Informative)
The study adjusted for severity of the illness or injury. It also adjusted for the age of the patient.
Disclaimer: I RTFA and then clicked on the link and read the actual paper where all of this is explained.
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It's more an assumption than an adjustment. Despite the ~20k diagnostic codes in ICD-10 they don't accurately reflect the individual severity, like all dehydrations go under E86.0 from light to severe. The doctors work shifts and take the people that come but if there's more than one doctor at the same time serving a queue there might be a subtle prioritization that the best one handles the worst cases or the junior doctor takes extra many easy cases skewing the statistic.
Our study has several limitations. First, our findings would be confounded if older physicians, on average, treat patients at higher risk of 30 day mortality because of factors unmeasured by our analysis. We specifically chose our within hospital study design to deal with this concern, hypothesizing that patients are essentially randomized to hospitalist physicians of various ages within the same hospital, an assumption supported by the largely similar demographic and clinical characteristics across patients that older and younger physicians treat.
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A class case of correlation not being causation - something lost on a lot of younger generation researchers, it seems.
A class [sic] case of a shit-wad on slashdot who didn't read the study before spewing shit from his mouth.
You called it. (Score:2)
Patients WITH MORE SERIOUS ISSUES tend to be allocated to MORE EXPERIENCED (ie: odler) DOCTORS.
You called it.
Control for that classic selection bias was conspicuously absent from the description of the methodology.
(I was about to point this out but you beat me to it, and did so very nicely.)
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How do we know that older patients don't just like going to older doctors?
We know that by clicking on the link to TFA, and then clicking on the link to the actual paper, and reading about how they corrected for that in the data by comparing same-age patients.
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Flawed anonymous comment. The headline doesn't imply causation, and I bet the study doesn't, either.
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- or is it just sloppy reporting (yes, I know, shocking, here on slashdot)? I haven't read the article, only skimmed the summary, and while the article points out that this is a study on US data, the summery here doesn't. The mention of the BMJ and Medicare in the same sentence appears incongruous, as Medicare does not exist in UK. This doesn't do much to boos my confidence in the quality of the conlusions of the report here on slashdot - statistical analysis is difficult any way, and I rather suspect that
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The mention of the BMJ and Medicare in the same sentence appears incongruous, as Medicare does not exist in UK. This doesn't do much to boos my confidence in the quality of the conlusions of the report here on slashdot
The authors were from Harvard.
BMJ is an international journal.
Re: Flawed study (Score:2)
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How do we know that older patients don't just like going to older doctors?
I was going to post, but hey.. you hit the nail right on the head in the first post! :)
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How do we know that older patients don't just like going to older doctors?
In many localities, there is a shortage of family doctors. Ergo, the seniors who found their doctor some 20 years ago, are still with the same doctor. I am with my family doctor for the past 20 years. In a few years he will retire. And when I arrive for the semi-annual checkup (bp, pulse, urine, and complaints), his waiting room is filled with seniors, 60+
1.3? (Score:1)
10.8 to 12.1 is only a 1.3 difference. That seems like a lot better odds than my odds with no doctor.
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Physician, heal thyself (Score:2)
And the problem solves itself.
Re:tl;dr (Score:4, Interesting)
You seem to presuppose that a longer time between admission and death is necessarily a good thing, and that doctors who don't score high on that has "lost ther edge".
I'm not sure your premise is correct. A doctor who resorts to induced coma will score very well for that premise, but that does not mean he's a good doctor. A doctor that can't explain that a person is brain dead and that life support should end is not doing a good job either. And a doctor who prescribes expensive treatments that patients and families can ill afford, while it only prolongs life in agony is IMHO a worse doctor than one who sees where palliative care is a better solution.
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doctors with lighter patient loads lose their 'edge' and have higher patient mortality rates compared to doctors who see more cases
Or the admissions nurse only sends patients to the "bad" doctor when all the "good" doctors are too busy with other patients.
So many possible confounds (Score:4, Insightful)
I run a Help Desk. The reps who do the most tickets are not the best. That's because the best reps can fix issues without escalating, but that takes time. Do doctors who take many patients mostly do the easy stuff? Are the doctors who take fewer patients specialists in their field, or handling more difficult cases that take more attention per patient?
Does seniority mean they take more difficult cases? Does seniority mean they care less about their malpractice insurance (because they are more secure financially)? Does seniority change which patients seek you out?
There are so many potential confounding reasons for this correlation that do not depend on the doctor being less capable or providing worse care in some manner. I'm not saying that there is no cause for concern... I'm saying that the study has potential confounds that its statistical groupings did not eliminate.
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Re:So many possible confounds (Score:5, Informative)
Do doctors who take many patients mostly do the easy stuff?
The study adjusted for severity of injury or illness. So, no, that is not the explanation for the age disparity.
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I thought about the same bias. However, when it comes to doctors, I have to say this study matches my perception. On average, I had much better experience with young doctors than older ones, for a simple reason : older doctors tend to think they know everything and tend to make shortcut decisions. Younger doctors seem to be more likely to question their conclusions and triple check everything, potentially asking specialist colleagues for confirmation.
Again, that's just my experience, doesn't mean it's true
Which Doctor? (Score:5, Funny)
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Considering gender difference (Score:3)
Doctors over 60 are disproportionately male. The gender ratio for young doctors is relatively balanced.
It has been shown that female doctors have slightly better statistics for outcomes than male doctors.
http://jamanetwork.com/journal... [jamanetwork.com]
The JAMA study uses the same patient group as the old-vs-young study, that is hospitalized Medicare patients.
And they both looked at performance of hospitalists.
As near as I can tell, the gender ratio for hospitalists is more balanced than the all-doctors gender ratio, but I can't easily find numbers of age vs sex for hospitalists.
Another factor might be that hospitalists can migrate to be a specialist (waaaay more money), but that's not an option if you're not a very good hospitalist, so perhaps the old ones are a combination of dedicated hospitalists (the ones with large patient loads and good outcomes), and the ones that didn't advance (who may be just marking time).
So, I got curious and looked at both studies (but only the abstract for the JAMA). The difference in outcome between male and female hospitalists is smaller than the difference between young and the over 60 year old doctors. If I read correctly, the female vs male patient death difference was 11.07% vs 11.49%, but the young vs old was 10.8% vs 12.1%.
So it appears that age is a much greater factor than sex.
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Well guys, don't kid yourselves (Score:1)
You cannot get health care in america with the start of the trumpcare age, so why bother with doctors at all.
Except that it isn't correlated to age... (Score:1)
... the study says in its very own conclusions:
Patients in hospital treated by older hospitalists have higher mortality than patients cared for by younger hospitalists, except for hospitalist physicians with high volumes of patients.
In other words: It's not the age, it's caseload. Old doctors who receive a lower number of cases have a higher mortality rate. Maybe they're lacking the experience that other doctors their age have. Or maybe they receive less cases because they are known to be not as good as other doctors (either because they don't get the same jobs, or because they receive less cases on purpose).
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... the study says in its very own conclusions:
Patients in hospital treated by older hospitalists have higher mortality than patients cared for by younger hospitalists, except for hospitalist physicians with high volumes of patients.
In other words: It's not the age, it's caseload.
In surgery, high volume has often been associated with better outcomes. The Veterans Affairs system studied outcomes in all their hospitals for colon cancer. They found that the best results were in hospitals with higher volume, and doctors with higher volume (as I recall from the article). One of the factors associated with better surgical outcomes is having teams regularly working together. It was a convincing study because for everything they found, you could understand why it would affect quality. (I.e.
Medical researchers can't do math (Score:1)
As this study proves yet again. Even with a supposed 700K gross value to impress the journalists, the relevant cohort comparisons are only a few per cent of that. Then they average the averages, which we all know does not work in general. They say they "corrected" for various factors, but the uncertainty in those "corrections" dwarfs the differences in results. This is just another blatant number fudging exercise to show a preconceived result. It's no wonder that 70-80 per cent of studies like this can
Stupid Study (Score:2)
House (Score:2)
Young doctor: "It's lupus!"
Old doctor: "It's never lupus"
For a symptom that occur 90% in an innocuous disease and 10% in a deadly ones, older doctors that saw lot of patients with the common one will diagnose the former while younger doctors who still believe to be able to find the rare one in their life could diagnose the latter.
Be careful with statistics (Score:1)
It's very easy to draw wrong conclusion.
Imagine, for instance, that MORE DIFFICULT cases are handled by older doctors.
And suddenly higher mortality rate doesn't tell you much about how well they perform.
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It's very easy to draw wrong conclusion. Imagine, for instance, that MORE DIFFICULT cases are handled by older doctors. And suddenly higher mortality rate doesn't tell you much about how well they perform.
Completely agree.
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I wonder if they corrected for (Score:3)
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Not only that, it seems reasonable that Junior doctors can avoid hard patients or avoid them better than older doctors can. The impact of failure to a Junior doctor's career is greater than an older doctor who has a shorter time left to practice. On the other hand, Doctors may need to experience failures in order to become better doctors.
What, no Peter Capaldi jokes? (Score:2)
... and I thought this place had a sense of humour.
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I came here for that, but then the power flickered and by the time I had reconnected, you had beaten me to it.
Newsflash: People stick with ... (Score:2)
... their doctors even as they get older.
Film at eleven.
I wonder:
Did the PhD get 500 000 in funding for this?
Correlation does not mean causation (Score:1)
Do you give a 30 year old doctor the risky heart surgery or the experienced vet? Of course the mortality rate goes up!
Control for year of training/qualification? (Score:2)
This is the real reason (Score:2)
Reversing Cause and Effect (Score:2)
I think they're reversing cause and effect here. Doctors whose patients keep dying have fewer customers left.
Ageism (Score:2)
Learning new techniques (Score:2)
Unfortunately I can't find the article (possibly something about Atul Gawande) but it said that a typical doctor does most of their learning at the start of their career and that consequently it can take a generation before new best practice is adopted. If this is true then it could be that the older the doctor the more likely you are to be treated using outdated techniques.
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As a practicing non-physician American healthcare provider, patients are typically our third biggest problem (after insurance companies and healthcare administrators). That is, patients often don't do what you tell them to.
Perhaps you should stop telling them what to do, but give options. It's their life, not yours. And they're not problems; they pay your salary. Show some respect.
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Unless you're declared mentally unfit, you're only ever given options.
Option 1) Take their advice
Option 2) Don't take their advice
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That's merely a Hobson's choice.
Before that is presented, the doctor has likely made choices he doesn't present to the patient. That's disrespectful at best.