I came out of two years at Tufts with a head stuffed full of shiny new medical knowledge, itching for the opportunity to put all of that learning to work. In this first month at St. Mary’s, the realization that has nagged me for the past two years has been driven home. They were right- I really don’t know a lot. It isn’t just new information about organ systems or procedures or diseases either. There are many aspects of being a doctor– leadership, teamwork, resolving conflicts, communicating with patients and their families — that are every bit as important to being a good physician. The sobering part of the story is that each day confronts me with things that I thought I knew well but don’t.
Case in point: dealing with “difficult” patients.
Every doctor has their stories of the patients who come seeking care but whom, for various reasons, don’t make helping them an easy thing. The “difficult” patient is sometimes rude, making unpleasant remarks, yelling, or swearing at the staff. Others will understand the changes they need to make in their lives to manage a heart problem and then go home, not take their meds, eat a daily triple-decker cheeseburger with extra salty fries and a large Coke, and cuss you out when they wind up in the ER with heart failure. Perhaps even more insidious are the patients who have legitimate medical problems that require attention, yet battle with other demons in their life. They come with pain that seems to be everywhere and ask, “Doc, I hurt all the time and nothing makes it better… any chance I could get a script for some Oxys?”
During two years of school, we listened time and again as senior physicians, wise with years of experience, told us, “You will encounter patients who will test your skills and your patience. Remember that you are there to help — never fall into the trap of letting your emotions get in the way of doing the right thing for your patient.” After hearing that enough times in the collegial atmosphere of the lecture hall, it’s easy to begin feeling like you understand and are ready to handle anyone that comes in the door. Then you encounter the patient in the ER at 11PM on a weeknight who starts yelling at you before the echo of ‘hello’ has left the exam room. As your temp starts to climb, your jaw tightens, and your sentences become shorter, those words of advice become faint.
Nearly every week brings one of those patients and I will be honest — it has been a huge challenge. Sometimes I can see beyond the words spoken out of fear, pain, apathy, or frustration and focus instead on what it is that caused that person to seek care in the first place. Sometimes I can’t.
The truth as I see it is that doctors are every bit as human as the patient, but the job sometimes requires them not to be. I have witnessed a broad spectrum of responses among the physicians with whom I have had the opportunity to work. Some of them should be sanctified for their poise, patience, and ability to see through harsh words to the very heart of what matters most in the encounter- the care of the patient. There have also been the times, however, when the response to a “difficult” patient has been clouded with emotion and, as a result, the patient left having not gotten some or all the care that they need. I wish I could say that I always land in the former category, but that’s not the case.
Each encounter with a “difficult” patient shows me that I don’t know as much as I thought. I’ll get hung up on the negative aspects of the encounter and lose sight of what is important. That’s when I’m met with a knowing smile and gentle reminder from a preceptor – “Believe me, I know that one can be difficult to deal with. Just remember that patient still has diabetes and hypertension. It’s your job to not lose sight of that.”
Until then… baby steps.