How the urge to please your doctor can work against you
Have you ever felt the urge to reassure your doctor that you’re fine? To dazzle them with your good habits, or convince them that nothing serious is going on?
It happens in my office all the time.
A patient in her 70s recently came to see me after her second trip to the ER for a serious fall. “I’m just a little clumsy,” she told me with a wink. “You don’t need to worry about me.”
And if I’m honest, the urge to be reassured is real. What doctor doesn’t enjoy feeling unburdened by concern or impressed by a patient’s fortitude?
Another patient told me last year that she’d quit drinking largely because she wanted me to be proud of her. I was proud of her. But I immediately felt uneasy that she’d handed me a piece of her self-esteem to hold.
So I started wondering: why does it feel so good, for so many patients, to please the doctor? Why do I, when put in the patient role, round up when asked the number of days per week I exercise—and round down the number of drinks I consume?
What’s in it for patients? Is it to shield doctors from concern? Is it to avoid hard conversations or risk being lectured? What’s the big deal about racking up a few brownie points with someone responsible for your care?
It turns out, quite a lot.
Most obviously, people-pleasing is often an unconscious way to hide vulnerability. My patient who kept falling didn’t need a pat on the head. She needed an adjustment to her blood pressure medication, a reminder to get rid of the throw rugs at home, and a referral to physical therapy for her balance.
When I asked her about the impulse to tell me she was okay, she admitted this: “I suppose if you’re not worried, I don’t have to worry either.” She was using my reaction as a bellwether for her own—a concern that was very much present, just buried under her fears about aging and losing her independence.
It can also mean outsourcing your intuition. My patient who quit drinking had spent years ignoring (or perhaps not noticing) how her drinking made her feel, using my imagined approval as her benchmark instead.
So, when we met, I made sure she saw the evidence for herself: her liver enzymes and inflammation markers had normalized, her blood pressure had settled. And I asked her to tune in to her sleep, her mood, her relationships, her energy.
Moving the benchmark from my reaction back into her own body, she later told me, is what helped her stay sober.
The urge to people-please in the doctor’s office can corrupt the very information doctors depend on. The patient who tells me she’s been taking her medication every day when she hasn’t isn’t lying, exactly; she just can’t bear to disappoint me.
But that small fiction sends me down the wrong path: I assume the drug isn’t working, so I might raise the medication dose or add another drug, and now we’re chasing a problem that was never there.
The most useful thing you can hand your doctor is the truth, as unflattering as it may be.
Here’s the part that surprises people: pleasing can get you more medicine, not less. The patient who doesn’t really want the test, the referral, or the third follow-up—but says yes anyway, because declining feels rude—ends up more poked, prodded, and prescribed than their body ever needed.
Agreeableness has a cost, and sometimes you pay it in procedures.
The dynamic runs both ways. Doctors are busy, and we’re human, too. A cheerful, unconcerned 2 o’clock patient can be a welcome reprieve from the complicated case waiting at 2:30. But that relief can also keep us from digging deeper, letting our wish for an easy visit quietly override our obligation to be thorough.
Of course, we doctors carry our own biases. If I start to think of you as more capable, less sick, or better equipped to handle illness or difficult news than the facts suggest, I risk co-writing that story with you—even subtly adding pressure to the very tendency that got us there.
Imagine if I’d decided to motivate my newly sober patient with something like, “Keep making me proud!” Would she have come back to me when she relapsed a year later? Or would she have disappeared, ashamed, exactly when she needed help most?
None of this means deference is bad. Doctors love agreeable patients! We welcome kindness. The instinct that makes someone a “good patient”—conscientious, respectful, willing to follow through—is often the same instinct that builds a real relationship with a doctor.
The problem isn’t kindness itself. It’s when kindness becomes performance, and when performance buries the truth.
In my book, I call this patient personality the “Pleaser”—one of a handful of patient personalities I’ve come to recognize over 25 years of practice. We all bring a version of ourselves into the exam room.
The Pleaser brings the one who wants to be liked. (PS. You can pre-order Beyond The Prescription where I dig into all the patient personality types here!)
So here’s the question I’d leave you with, the one worth sitting with before your next appointment: when you walk into your doctor’s office, which version of you shows up?
And is it the version that’s actually going to get you what you need?
Drop your comments below. I’m all ears!
See more here substack.com