We’ve all seen patients whose personalities grate on our nerves or even outright infuriate us. Someone recently asked me how to deal with difficult patients, but I lost their question. So how do you get through a tough patient encounter in such a manner as to maintain your professionalism, your courtesy to the patient, and your sanity?
1. Bite your tongue. Not everything you think needs to be said to the patient. Write a blog post about your frustration later.
2. Be attentive to what they’re saying. Acknowledge their concerns by paraphrasing them or echoing them back.
3. Thank them for their concerns or even their complaints. My program director sometimes answers complaints with something along the lines of “thank you for letting us know about that. We want your experience in this office to be a good one, and we can only change and fix problem areas if patients like you make us aware of them.” We don’t always change, but it does help the patient feel like their complaint has been validated.
4. Realize that personality disorders are a real thing, and your patient may have one. If you think something’s off, or the patient is always difficult to deal with, maybe that’s your answer.
5. Realize that your own personality isn’t for everyone either. Some people just don’t gee-haw, as we say in the south.
6. As my psych attending in med school taught us, never try to reason with an unreasonable person. If the patient is talking completely crazy because they’re mentally ill, don’t try to reason with them. They will not see things your way. You’ll end up with a headache.
7. For the patient who has been seen 10 times already for fatigue or headache or vague symptoms, organize yourself before you see them. Try to anticipate questions they may ask you and be prepared with an answer. Come up with a plan to address their problem, and ask for help from other docs. Sometimes they may come up with something you haven’t thought of.
8. Set an agenda for the time you have available with the patient and have the patient prioritize their concerns. Let them know that their concerns are important to you and that they each need proper attention, and that may not be possible in one office visit.
9. Set your emotions aside. You can be boiling with rage or feel like you’re about to melt in a puddle of tears, but don’t let the patient know. If you let your frustrations take over, the encounter will go all to poop. Save your tears/screams/punches for a broom closet later.
10. Kill ‘em with kindness. Don’t put on a fake smile or be patronizing, but think about how you would want to be treated, especially by your own doctor. Try being as nice as possible to them, even if you’re mad, and see if the interaction doesn’t improve. Even if the patient is still rude, you will feel better about your part in it. And the patient will gain no ammunition from your behavior to use against you.
Do you wish you had done anything differently in college/ med school? What is your best advice to a younger person considering medicine? -anonymous
how do you ‘know’ you want to go into medicine? what are some questions you should ask yourself before heading off and committing your life to being a doctor? -anonymous
I wish that I had studied smarter and learned better study techniques in undergrad. And I also wish I hadn’t spent my weekends sitting around my dorm all the time. I’m a homebody at heart, but I also think I missed out on a lot just sitting at home.
My advice for the young ‘uns is to be ABSOLUTELY sure you want to be a doctor before even applying to med school.
Ok, I guess you can never be 100% sure of yourself in medicine. But you need to not have any major qualms about the career before pursuing it.
How can you be sure? Do lots of shadowing. See what it’s really like. Don’t base your decision on TV medicine. Watch them do the boring stuff and find out how much of their day is eaten up with paperwork and phone calls. Ask doctors you shadow why they went into medicine. Ask them if they would do it all over again, and why not if their answer is no. Don’t assume that you are the special unicorn who is immune to burnout and cynicism, because guess what? You’re not.
Ask yourself if you can be happy doing anything else besides medicine. If so, do the “anything else”. Or at least take some time off between undergrad and med school to figure things out. Once you’re in this thing, you’re in it to stay, and it is the most difficult, stressful, painful thing you will ever do. Approach a career in medicine the same way you would approach a marriage. Divorcing medicine is probably as painful and just as messy as divorcing a spouse.
Also, DO NOT go into any career to please anyone else. You’ll end up miserable very quickly and in a huge pile of debt. Disappointing your parents or significant other for a short time is worth it compared to disappointing yourself on a daily basis.
I just went on a first date (really relaxed, almost more of a hangout) and I really like the guy. I was disappointed when he didn’t make a move at the end of it, and then I realized (with help from an ex) that I might not have been forward enough, because I’m pretty shy when it comes to relationship stuff. It’s possible he didn’t feel my interest at all. I really want to try and salvage this, but don’t know how. Any advice? - anon
Ok, let me first give my standard disclaimer when it comes to relationship advice: I have never dated. I do not have personal experience with any of this stuff. But I have watched a lot of other people do stupid things in their relationships, and I can offer an opinion about these things.
Sorry for the slow response. I couldn’t really think of a great answer for you.
The biggest thing that surprised me about med school was that it was HARD. That sounds like a cop-out answer, but no amount of warning can prepare you for how hard it actually is. I had no idea what I was getting myself into.
Another thing that surprised me was that there were people in school with me who clearly had no interest in patient care (or ever interacting with other human beings ever) almost from the get-go. These people started out med school with cynicism, and it just got worse and worse as they went on. It doesn’t make much sense to me. Why go into a frustrating job like medicine where you’re forced to deal with hard to deal with people on a daily basis if you clearly have no patience for it?
Things I wish had developed earlier:
Things I’m glad I had:
I get a lot of questions in my ask box about how a high schooler can pursue his or her interest in medicine. Finally, after hours of pondering, I have completed this how-to guide for high school pre-medders.
- First of all, slooooooooooooow down. You are still in high school. This should be a time of fun and exploration (and I don’t mean of the sexual and chemical kind).
I’ve gotten quite a few messages in my inbox requesting private answers to questions that boil down to something like the one below. The specific numbers don’t matter that much for the purposes of answering the question.
23. I have excellent extracurriculars, but my grades are so-so and my MCAT isn’t great. Do I have a chance?
In case I haven’t conveyed it effectively in the past, let me take a moment to reiterate…
MED SCHOOL IS HARD.
Extracurriculars are great, but they are extras. Icing on the cake. Yes, you need them (to have a desirable cake), but they are not the basis of your application to medical school (otherwise you’d be all icing and you’d give someone diabetes…). Extracurriculars can help give a boost to mediocre numbers (like rich chocolate icing on a dry boxed yellow cake), but they can’t really stand on their own.
The goal is not to GET IN to medical school. The goal is to GRADUATE from medical school. Amirite? If you hope to get through, you need a solid foundation to build upon.
Now y’all know I hate talking numbers, but the truth is that they DO matter. I’m not here to set minimum standards for medical school applications — most med schools have already done that — I’m just sayin, be realistic. Check out the schools you’re applying to. Your scores need to be at or above their average if you want a good chance of getting in there. Yes, people with lower scores get in, but don’t hope to be the exception. Try to be the rule.
If you are in such a situation, what can you do to improve your numbers?
1. Don’t get complacent. If your study method wasn’t working the best last year, change it! Second year is harder, duh.
2. In that same vein, if it ain’t broke, don’t fix it.
3. Enjoy the occasional bits of humor hidden in Robbins and Cotran Pathology. ( I did Path first year, but it’s my understanding that most traditional schools do it second year).
4. Take a first year under your wing and help them get through. Give them your notes, call them occasionally, take them out for coffee. If your school doesn’t have an official big sib/little sib program, start one.
A new academic year is beginning, which means there is a whole new crop of thousands of first years who are, at any given moment, this close to peeing themselves out of excitement or utter fear. So to calm your worries, I’ve compiled a little advice column. Here goes:
1. Don’t look at the cadaver’s face on the first day of dissection. Save that emotional challenge for a week or two in.
2. Take the amount of time you think you’ll need to study and double it. Seriously.
3. Yes, you really do have to know that minute detail about the alpha subunit of the cholera toxin molecule (there’s a reason why I still remember it. Hello first day of medical school… ah the memories).
4. Don’t pull all-nighters. If you don’t know it by 10pm, you won’t know it at 3am.
Sounds like common sense, but a lot of people fail on this. Your patients can’t follow your advice if they never heard it to begin with.