The Alienated Patient
Left Behind by Modern Medicine
Modern medicine has produced a vast and growing class of patients with chronic, unexplained symptoms. They are everywhere. I encounter them daily in the ER, and they are easy to find on social media, where whole communities have formed to share grievances and trade theories. These patients are not malingerers. They are genuinely suffering. Yet, the structure of medicine today leaves them stranded, repeatedly told what they do not have while receiving little help in discovering what they do.
Their episodes are uncomfortable but not immediately dangerous. They dutifully see their primary care physician, who, reluctant to miss something catastrophic, refers them to the emergency department. There, a battery of tests is ordered: blood work, imaging, an electrocardiogram. The physician expects these studies to be negative, and they usually are. Occasionally, two or three values stray just beyond the arbitrary limits of “normal.” An albumin slightly elevated. A relative eosinophil count slightly low. These anomalies are clinically meaningless, yet they appear in the patient’s electronic record, flagged with red exclamation marks.
The doctor tells the patient that the results are “reassuring” and may even summarize them as “normal.” What the patient hears is something altogether different. They see flagged results on MyChart, but hear from the doctor that everything is fine. To them, this feels like dismissal or even dishonesty. They believe their symptoms are real and are unsettled by the presence of abnormalities on objective tests. When told there is no emergency, they interpret the message as “nothing is wrong with you.” They leave not reassured but alienated.
This cycle repeats. The patient returns to their primary care office, where liability concerns again often dictate referral to the emergency department. Once more, the ER performs its ritual exclusion of life-threatening pathology. Each time, the patient is told that no emergency exists. Each time, the patient hears that their suffering has no cause and deserves no explanation. Their visits multiply. Their frustration grows.
Over time, the patient’s medical record accumulates dozens of encounters. Emergency physicians opening the chart let out a sigh before they enter the room. They see a long trail of “negative workups,” innumerable phone calls, and the note that this individual is a “frequent flyer.” The patient’s symptoms remain unexplained, but now their chart contains a new label: “difficult patient.”
This label is a self-fulfilling prophecy. A clinician who expects a challenging encounter often finds one. The patient, for their part, expects to be dismissed yet again, and so the relationship begins in mutual suspicion. The visit is adversarial before the first word is spoken.
It is not long before the patient turns to the internet. In online communities they find others with similar symptoms. Some of what they read is accurate, much is not. They begin to self-diagnose, sometimes correctly, often not. They arrive to the ER armed with theories from social media, which the physician promptly rejects. The patient feels patronized. The physician feels undermined. Trust collapses completely.
What began as a simple set of unexplained symptoms has now metastasized into something larger: the destruction of the doctor–patient relationship. The patient feels gaslit, unheard, and abandoned. The physician sees a hostile, difficult, and uncooperative individual. The system, in its drive to avoid liability, has manufactured an adversary where once there was only a person in need.
The roots of this alienation are many. Defensive medicine plays its part, ensuring that every encounter revolves around ruling out emergencies rather than investigating the underlying cause of suffering. Corporatization contributes as well, replacing continuity with fragmented, episodic care. Algorithmic protocols substitute for individualized judgment, reducing the physician to a technician of guidelines rather than a counselor of persons. The culture of medicine enforces this conformity. Few are willing to “go off the reservation” and attempt creative or off-label approaches to chronic illnesses of unclear cause. We follow the algorithm, and when the algorithm is exhausted or when the patient does not fit the prescribed box, we shrug and refer them elsewhere.
The cost of this neglect is profound. Patients like these often develop secondary psychiatric symptoms: anxiety, depression, and a relentless vigilance toward every bodily sensation. These symptoms arise not only from their unresolved illness but also from their growing conviction, reinforced by the help they seek online, that medicine is dismissing them, gaslighting them, and overlooking something serious. The psychiatric distress feeds back into the original complaints, amplifying them in a somatiform fashion.
At this stage, physicians often begin to interpret the entire syndrome as psychosomatic. In some cases this may be correct, for there are patients whose illnesses are rooted primarily in psychiatric causes. Yet in many cases the conclusion is premature. Whether the symptoms have a psychological component or not, the patient hears the diagnosis as an even sharper dismissal: there is nothing wrong with you, you are just crazy. Their physical suffering is compounded by the anguish of not being believed. The healthcare system, which congratulates itself for excluding emergencies, has delivered no answers, no relief, and no trust.
The alienated patient is the shadow cast by defensive medicine. When care is driven by liability and protocol rather than curiosity and relationship, trust begins to erode. Patients turn elsewhere, to online communities, to self-diagnosis, and sometimes to quackery. They are not rare. They are produced every day in emergency departments and clinics across the country. The damage is not only medical but relational, and it leaves scars that no drug can heal. The true cost of defensive medicine is not counted in tests or dollars, but in broken trust, and once lost, that trust is seldom regained.
This essay is part 2 of a series on defensive medicine. Read Part 1, “The Price of Torts,” here.