A few years ago, Christina Thielst, a health care administrator based in Santa Barbara, California, called her primary care doctor for an appointment. She’d been experiencing some alarming symptoms — fatigue, numbness, pain in her limbs — and she wasn’t getting anywhere with the neurologist she’d been seeing, who advised only physical therapy and time, even as things got increasingly worse.
So she left a message with her doctor’s office manager, then waited. And waited. But the call back never came. (Thielst was eventually diagnosed with Guillain-Barre syndrome after seeing a different physician, this time a neuromuscular specialist.)
“I was ghosted,” she says. Her theory is that one of two things happened: Either the doctor didn’t communicate clearly with her staff, or the person at the desk never passed on messages. Either way, though, the result is the same. “You just feel like your doctor wasn’t there for you.”
A study of primary care doctors from 2017 found nine out of 10 have dismissed a patient. And that doesn’t even take into account the patients like Thielst, who were de facto dismissed by a doctor who never returned their calls.
As frustrating as it can be to suddenly find yourself without a physician, the average patient shouldn’t be worried, says Dr. Ann O’Malley, author of the aforementioned study: “When you look at the quantitative data, you know, beyond the anecdotes, it’s actually a very small number of patients who get dismissed by their primary care practices.”
O’Malley, who has spent over two decades researching primary health care services, says that while horror stories of doctors going MIA might generate attention, practices are generally pretty reluctant to formally dismiss patients. “They are the primary care kind of point of access to the system and they understand that,” she says. “And they’re in it for the long haul of having an ongoing relationship with their patient.”
It’s easy to overlook that the connection between a doctor and a patient really is a relationship.
Thielst clarifies there might be a difference between “firing” and “ghosting” when it comes to patients. Firing, she says, happens due to inappropriate behavior by the patient, usually after substantial effort to maintain a healthy doctor-patient relationship. Ghosting could be a variety of things: The doctor could have left the practice. You could be the victim of an administrative failure, where a practice has poor customer service processes and doesn’t return calls. You could even have a doctor who won’t use the phone but will communicate through a patient portal, or vice versa.
Family physician Dr. Pamela Wible says patients can be fired for a variety of reasons. Wible has dismissed patients who have had explosive or abusive outbursts, which makes for an unsafe working environment for staff and a tense caregiver-patient connection. Being noncommunicative is a big one, too: “I’m all for people making their own informed decisions about how they’d like to handle their own medical problems,” she says. “But if they’re not returning phone calls and not communicating with me, I can’t be responsible for having a relationship with them and be held accountable for things happening or not happening.”
“This is a relationship in which life-and-death decisions are being made,” she continues. “And if for some reason, you’re not on the same wavelength, you’re not able to communicate, if there’s tension in that relationship that makes it impossible to advocate for the other person, then it’s maybe a failed relationship.” It could actually be safer, Wible points out, to refer the patient to a doctor they would communicate with better.
Given the vulnerability many people can feel when discussing their most private problems with a near-stranger — or, on the other hand, the sometimes transactional nature of seeking an answer to a medical question — it’s easy to overlook that the connection between a doctor and a patient really is a relationship. It’s not the medical equivalent of a self-checkout, where both parties can breeze through on autopilot, and it’s also not a lopsided affair where one party holds all the power.
Wible believes there are steps patients can take to cultivate a positive relationship and ensure their needs are met.
“I think it’s a great idea to limit what you discuss during the visit to what makes sense to handle during that time frame,” she explains, noting that an emotionally loaded, complex issue shouldn’t be squeezed into the 10-minute slot designated for a prescription refill. “Get organized in your own thinking so that your objectives for the visit can be met in the time frame of your visit.”
For other doctors, the key to keeping things on the right track is even simpler: call. Dr. Christine Gest, a clinical cardiac electrophysiologist, says calling ahead when you can’t make an appointment is an easy courtesy that’s too often overlooked, but that can be a game-changer in terms of maintaining a positive rapport. At her practice, if a new patient is a consistent no-show, the staff will eventually refuse to reschedule them. Gest says if she knows the patient well and is aware of extenuating circumstances, her office tries to work with them, but otherwise, extreme no-shows are given 30 days’ notice via registered mail that the practice can no longer take care of them.
“It’s not fair to other patients who may need to be seen,” Gest says, noting that while she doesn’t charge for no-shows, other doctors might. There’s also a labor element that goes unseen when you blow off an appointment: “A day or two before they come in, the medical assistant actually goes to their chart and makes sure that, as much as possible, it is up to date,” she says. “They do a chart prep. And that takes staff time.”
In other words, don’t ghost your doctor if you don’t want them to ghost you. Despite the added nuance of the doctor-patient bond, the fundamentals of interpersonal relationships still apply: Pay attention. Check in. Call if you’re running late. “Treat the doctor like a human being,” Wible says. “We are human, and so if you act like a human being and treat the other person like a human being, you’ll actually have a human relationship. Which is the basis of health care, the human relationship between the doctor and the patient.”
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