The Difficult Patient

I was doing an ER shift today when I came across my first difficult patient. Mr. K was a 50 year old divorced man who came in irritably on a stretcher having passed out from COPD exacerbation. He was shaking all over and showed a distrust for the medical system: the paramedics that brought him in, the nurses, the entire system.

Nothing destroys a relationship with a patient faster than distrust and I realized it was going to be a tough situation as soon as I took his history. “Jesus ****ing Christ, Why are you asking me again! I’ve already told you guys ten times what my medical history is like! Just do what you need to do and get me out of here.”

It was uncomfortable, after discussing with my preceptor, to go ask more follow-up questions and do a physical exam. I felt defeated and flustered. What knowledge and competence I had about his condition evaporated once his bitter criticism hit me. For the most part, the limited patient encounters I had before were generally positive with them being encouraging and understanding that I was still a medical student. There’s always two sides to a coin.

After the shift while walking home, this difficult patient encounter lingered in my mind. I guess sooner or later, every medical student becomes a bit more cynical and pessimistic. Their young idealism and optimism is replaced with harsh reality, death and disease. And although I remain positive about medicine, there are hard lessons and growing pains to be experienced. Even though it is difficult, I will continue to respect and treat my patients with dignity, irregardless of religion, race, age, disease or attitude.

Medicine is interesting in this respect. It not only builds knowledge, but also character. You slowly begin to realize what kind of a person and eventually what kind of a doctor you will become with each patient encounter.  I hope I can become a doctor my patients trust.

4 Responses to The Difficult Patient

  1. A doctor I work with says his favorite thing about the work is the personal growth aspect, for what it’s worth.

    • medaholic says:

      I think even with all the cool science, new technology and breakthroughs in medicine, the most rewarding aspect for me is still the personal interactions with patients. Getting to know them as a person and their story. Finding common ground. Working together to achieve health.

  2. Joshua says:

    Although I’m still in 1st year of medicine, I’ve quickly come to appreciate how challenging patient interaction can be. I’ve had a patient begin to dose off in the middle of taking a history, and after asking him if he wanted to continue, said he couldn’t do this anymore. I’ve had a patient express frustration with his care, asking me why he can’t leave the hospital.

    At the same time, I have had very positive patients, sharing private details about their lives all the while recognizing I am here to practice and learn and being very patient with me as I make mistakes and improve on my weaknesses. Like you said, there are two sides to the coin.

    I think a lot of us tend to underestimate how challenging the “art” side of medicine can be. When we visit our doctors as patients, we view ourselves as kind, compliant, clear, etc. But the reality is that when people are very sick, have trouble with English, frustrated, etc. medicine can be quite difficult, which is why developing the soft skills in medicine so important.

  3. Christopher Ali Kuseri says:

    your not alone you meet such kind of challenge,,a’m also a victim of that,,now l realizing that a medical school is so challenging as far as comfused pts is corcened,,,bt the isue is we need to understand our principals as a medical practitioners and then apply it

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