Dealing With Problem Patients
February 01, 2004 | Operations
Every doctor has a "problem patient" war story, but primary-care physician Anne Biedel's will knock your socks off.
A retired schoolteacher began coming to her practice frequently, often for medically dubious reasons. The schoolteacher made Biedel's staff uneasy with her pushy and overbearing nature; sometimes she would just barge beyond the reception area, near the exam rooms, as if she worked there.
Moreover, she took an unhealthy interest in Biedel personally, and knew more about her private life than the doctor was comfortable with, even in a small town. And her attitude toward Biedel and her staff unnerved them — she was seemingly friendly, yet also vaguely menacing.
"She knew where I lived and where my daughter went to school, and at first she approached me as kind of, 'Hey, you know, I'd like to get to know you,'" Biedel recalls. "But hers was an unwelcome, uneasy presence in the office. ... She had almost like a stalking behavior. One day I came out of an exam room and found my nurse hiding under the desk. I said, 'What the heck are you doing under there?' And she said, 'Guess who's out there?'"
The last straw was when she appeared in the office on Biedel's birthday, eager to show her staff the "surprise" she'd cooked up for the doctor: she'd written "Happy Birthday" on her thighs.
Apparently the schoolteacher's feelings for her physician were more than professional, and more than friendly.
Patients as troubled as this are rare, but not unheard of. Doctors and their staffs can be magnets for the lonesome and the delusional. The quasi-personal nature of the physician-patient relationship and the casual, family atmosphere of most physician offices can be confusing to patients yearning for warm human contact.
"I'm a warm person by nature," says Aletha Tippett, a solo primary-care physician in Cincinnati, who had an experience years ago eerily similar to Biedel's. "I touch my patients. I get involved in their lives; I'm very close to my patients."
One patient who tried to get too involved haunts Tippett to this day. The woman was not satisfied with regularly scheduled appointments; she began trying to ingratiate herself into the day-to-day lives of the doctor and her staff. She would call daily, just to chat, or show up at the office with trays of fresh-baked goodies. Moreover, she was often rude to the staff, presumably viewing them as barriers to Tippett. They felt bad for the woman; they assumed she was simply lonely. But they did not have time for her incessant pestering and they tried gently to discourage her.
"I would tell her, 'You have to stop bringing us fudge,'" Tippett recalls. "'You have to stop calling. You can't show up here every day.' I wound up having her evaluated by a psychiatrist, and the psychiatrist said, 'You know, she's in love with you.'"
Both physicians knew that they would have to end their relationships with their lovelorn patients, and did so. Tippett's former patient still hasn't gone away completely.
"It's been seven years," she says, "and I still get letters from her sometimes. She'll say, 'I just wanted to check in to see how things are going.'"
The schoolteacher in Biedel's practice was even less cooperative. Although Biedel, who was in the process of leaving her group for a solo practice, had written the patient a letter informing her of the decision and offering her urgent care for 30 days at her former group, the schoolteacher showed up at Biedel's new office demanding to be seen. When she was firmly rebuffed, she stormed out of the office, seething.
Then she found a lawyer and sued. Because she had no legitimate malpractice claim, her action came under Washington state's obscure "tort of outrage."
"It was for this outrageous behavior I had supposedly showed her," Biedel says.
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