The Privileged Patient and the Grateful Patient

I have made a casual observation that charity inpatients are kinder and easier to empathize with than “pay” patients. Charity patients look at their doctors with such respect that they are afraid of disobeying their instructions. What you tell them, as their physician, is taken in full confidence. If the doctor says so, then it is so.

Of course this isn’t always the case. I have encountered charity patients that have gotten to my nerves but I have put forward this observation in order to present my view regarding that feeling of “privilege” among patients.

It is often said, and I agree, that health is a basic human right. Thus it follows that the quality of care between the rich and the poor should not differ. This however is a utopia. In reality the difference is a gaping hemorrhaging wound that is almost impossible to repair. We as healthcare providers know that, but we try to compensate.

This disparity has always existed that it has been engrained on the minds of poor families that doctors are not for them. Annual health checkups are for the white-collar job people and the businessmen, but not for them who only go see a doctor when the pain won’t go away after a month and the OTC pain meds won’t work anymore. In this way we have propagated the thought that health is a privilege and not a right, and that only the “privileged patient” gets the complete healthcare package.

Ironically the charity patients are most of the time the grateful patients. They have been accustomed to expecting so little that whatever you give to them they become so thankful. Even when the physician is only doing what he/she is supposed to, they consider this as such a feat of kindness that they don’t deserve. But they do deserve every ounce of empathy and service, same as the rich paying patients.

Giving service despite financial status is easier said than done. Everything runs on money. The idealists will disagree, but even charity institutions know this. As much as you would like to give medications, they aren’t free. You might think the government should provide for it or whoever it is running the charity hospital but, for whatever the reason, the medicine is not there. The frustrated physician cannot give everything or else he/she burns out. So slowly he/she learns how to harden his/her heart.

Who is to blame – the patients, for not living a healthy lifestyle and for having all those vices when they well know they don’t have money for hospitalization; or the government for not allocating enough for healthcare? I think it’s everyone’s fault, and everyone’s responsibility. No one should solely bear the burden of a rotten healthcare system.

Enter the “pay” patient. She comes in at 2am in the ER of a teaching hospital with a stomach discomfort. The interns attend to her, but she demands for a “real” doctor. She says she doesn’t want to be “practiced” at because she is paying the hospital bill. Well, the intern’s pride gets hurt and he leaves, but he curses silently. That’s the “privileged” patient, and she isn’t ashamed to flaunt it.

I don’t know when and how it started that patient-doctor relationships has been tinged with suspicion. It’s like some patients think they are being extorted, especially when they can provide the money. It’s a good thing suing doctors aren’t as rampant in the Philippines as compared to the US.

It’s easy to take for granted your health privileges when you can afford an MRI, an ExLap or a CABG, while other patients have to scurry and find money to pay for something as simple as an ultrasound.

The paying patients are usually tolerated when they are rude. What we were taught is to never argue with patients, and I absolutely agree. But I don’t know, maybe someone should tell them to be courteous too. It doesn’t matter that they can pay. It’s basic knowledge, respect people not just because they can do something for you but because it is the right thing. Even if you are paying for services, that doesn’t give you the right to be needy and demanding.

It always feels good when you are appreciated for what you do. It makes you even more motivated. When you’ve been awake for 28hrs already and your legs are edematous because you had to monitor 40 patients in a public hospital’s ward, the feeling that they are thankful you check on them and they respect and appreciate you makes the job perfectly okay. It makes you proud that you do what you’re doing – taking care of people.

Maybe it’s easier for the charity patients to be grateful because they have been dealt with worst things. Imagine having a child born with congenital hydrocephalus and you have a job that only gives you Php 10,000 ($217) each month. That won’t be enough to pay for hospitalization, maintenance medications, operation, and doctor’s professional fee, especially if you have other children to support. But I have seen patients who have it far worse and who are so financially impoverished, yet I’ve seen them smile and have faith that somehow everything will turn out okay. Every Thursday at this one particular public hospital for children in Metro Manila I see parents go to the Neurology out-patient clinics, some carrying their children and some in wheel chairs, to follow-up and they are so patient despite the long lines. They are happy when they get to talk to the doctors and are grateful for their time.

Charity patients should also feel privileged. We have PhilHealth that was created to assist them financially (hopefully it is really working for everyone, I’ve encountered patients who said they were lucky they have PhilHealth) and a few other charitable institutions like PCSO and the public hospitals.

Rich patients already know their privileges. Maybe what they need to understand more is how to be grateful for these. It’s easy to take for granted your health privileges when you can afford an MRI, an ExLap or a CABG, while other patients have to scurry and find money to pay for something as simple as an ultrasound. Wouldn’t it be a nicer world for patients and healthcare professionals alike if relationships were harmonious? No rudeness, no suspicions, and no accusations. Just open and empathic communication.

The privileged patient and the grateful patient shouldn’t be two different individuals. Every patient should be privileged, and it is the duty of healthcare professionals to offer them the services they need. In exchange, a little gratitude and appreciation would go a long way. Physicians and nurses aren’t ATMs who just take money. We aren’t machines, we are breathing feeling human beings who also need sleep and care. We sacrifice our sleep (and sometimes are own relationships) just so we can do our job well, so being smiled upon by our patients is a big motivation.

So, I don’t know how to end this. I’m sure each person has a different take on this topic, but that’s my two-cents. I respect any opinion for and against my views. Let me just sleep for I will be on duty again. Have a nice day!


5 thoughts on “The Privileged Patient and the Grateful Patient

  1. Jonathan Awori says:

    What a thoughtful post . . . you raise a central challenge in medicine, how to maintain empathy when the intended recipient is so disagreeable . . . I once had a patient be openly hostile at the mere suggestion that I would be talking to him before the attending physician. It was hard. I’m learning, however, that empathy can’t be conditional. Even the privileged, entitled patient has vulnerability on account of sickness or injury and is worthy of empathy. But a doctor can and should respectfully draw boundaries and speak in direct terms to a patient who is being rude . That is not inconsistent with empathy, and in fact supports it through honesty. We must preserve our humanity for ourselves and our other patients . . . thank you for your post.

    Liked by 1 person

  2. venusmarierojas says:

    Yeah it’s true, sometimes pain and any form of suffering makes someone a grouch… Once a patient dismissed me and looked for the ER consultant, but before she left she apologized that she just felt panicky.


  3. Ledgardo Lacson says:

    So you need patience to your rude patient,here in California when you go to ER, there is no rich or poor you will line to register to be treated base on the gravity of your situation or unless you arrive on ambulance. If you became rude to they easily call the police. That it’s

    Liked by 1 person

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