Recently at a Journal Club, my colleague Dr. Gary Duguay presented Dr. Edgoose’s article[i] regarding the Difficult Encounter between doctor and patient. This is a topic which is of course near and dear to my heart, if we can overcome the challenges presented by the difficult encounter, we can improve our diagnoses and patient outcomes.
These are some of the comments I heard on “the difficult encounter”:
- “There is a transformative power when one asks patients about their lives;”
- “I try to provide a sanctuary where my prisoners at the penitentiary can to be human, though it is only for a short time;”
- “I banter and side with the patient about the long wait and the often the patients seem to become calm;”
- “I understand why some will wait long hours with seemingly trivial complaints to see us. They are worried about their symptoms;”
- “The rare patient (one in four months) will drain me so much that I can’t multi-task after seeing them for the rest of the shift;”
- “I can handle a difficult encounter early in the shift but I can’t towards the end of the shift;”
- “I try to spit my demons out before seeing the patient.” This doc was asked what he meant by his demons. He replied, “I mutter that they are drug-seekers, or frequent flyers, or alcoholics, or some other critique of the patient.” He was asked whether he shared his criticism with the staff before seeing the patient? He replied “Yes.” It was suggested that he, “spit out his demons silently, because pejorative labelling is contagious, poisonous and dangerous. When a physician labels a patient pejoratively then the nurse takes this as a validation to judge the patient thus. Pejorative labelling lowers the meritocracy of the patient and too often due diligence and care are neglected. This criticism can be a tasteless poison that can settle permanently in a department. Sadly, it can become a way of doing business.” Chaucer said, “If gold shall rust then what shall iron do?”
- Another said, “I always try to think, ‘there but for the Grace of God go I.’ This gives me a compassion to mellow to the moment;”
- Finally, a woman physician remarked, “It was an amazing journal club. I thought I had died and gone to heaven. Guys talking honestly about their work and discovering the value of empathizing.”
Striving for aequanimitas,
John Mary Meagher
[i] Edgoose JY1, Regner CJ2, Zakletskaia LI2. BREATHE OUT: a randomized controlled trial of a structured intervention to improve clinician satisfaction with “difficult” visits.
[ii] Bertram S. (RN. MSN.), Pace W. (MD.) et. al; J Am Board Fam Med. 2015 Jan-Feb;28(1):13-20. doi: 10.3122/jabfm.2015.01.130323. “Communication is the Key to Success in Pragmatic Clinical Trials in Practice-based Research Networks (PBRNs)”.
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