#132 You can Change How You Think About Difficult Patients
Did you know this?
Cover by American Association for Physician Leadership
Every new year, I celebrate the fact that in January of 2022, I published Changing How We think About Difficult Patients: A Guide for Doctors and Healthcare Professionals. I am a retired emergency physician now author, book reviewer, thinker, and writer. I am not a very good business lady or publicist. No one would question me if I chose to concentrate on reading, tennis, lunching with friends, and walking my anxious miniature poodle, Dolly.
However, I am still pushing hard on this book and its message because some suffering nurse, physician, paramedic, PA, or NP desperately needs to hear my important message. The social workers too. Here is my pitch:
“This slender volume is a gift for suffering clinicians. Some interactions with patients and their family members really stink. The interactions leave clinicians feeling terrible and defeated. They resent some of their patients. The clinicians doubt their decisions to study nursing or medicine. It does not have to be this way. They can change how they think about difficult patients.”
This is a self-help book for healthcare professionals.
I discuss how both sides of the interaction react and how patients and clinicians have adopted some very unhelpful patterns of thought. Healthcare folks, in particular, have grown very cynical and negative towards some of our patients. Since everyone in the workplace shares some of these negative thoughts, it feels to us as though we are just observing the truth about patients who manipulate, frustrate, and do not follow instructions.
We grow to think that all the people doubled over in pain are just being dramatic to get more pain medicine. We are certain that the person with mental illness cannot possibly have some organic illness. We believe that the unhoused person with altered mental status must be drunk. Then when we make these gross assumptions, we collect evidence for our original thought and ignore the evidence against it. (This is confirmation bias.)
But what happens? We miss the spinal abscess in the man with back pain. The hot appendix in the lady with bipolar disorder is not diagnosed. We miss the closed head injury in the inebriated fellow and wonder why he cannot be awakened after a few hours. We and our patients get terrible outcomes. Everyone loses in the interactions.
What can harried docs and nurses do? We can ask better questions. We can lean in and find out why the folks are angry or non-adherent to the plan. What can we change or add to work with the patients whom we find to be so difficult? Can we listen to these folks and extend to them the benefit of the doubt?
We can change our thoughts about our most challenging patient interactions
This is the message of the book. By changing our negative thoughts, we can have better feelings about situations and become more curious and more empathetic. These positive emotions naturally lead to more productive actions like testing, procedures, and the correct consultations. With accurate information and diagnoses, our patients get better results. We feel better and our patients get better. Win-win.
When this lovely concept doesn’t go to plan, we fall back on our training and our confidence. We remember that the challenging interactions are infrequent. Most interactions go well. We recall the smiles and the handshakes. Even when outcomes are bad, medical professionals can remind themselves that they did all that they could. Sometimes, shedding a few tears or feeling the frustration is exactly the right thing to do.
The message of this book is that there are no difficult patients, just challenging interpersonal interactions that medical professionals can handle in a much more intentional way. It is not a quick fix. You may need to read the book again about every six months or so. It is so easy to fall back into the very toxic ways that we now think about our challenging patients.
My mission is to lessen the suffering of medical professionals around difficult patient interactions and to keep more of my colleagues practicing clinical medicine. I have a one-hour presentation that I can give at conferences or educational meetings. I am brilliant on virtual presentations. For program directors and CMO’s, I can give a presentation to your people. I can be messaged through my website: https://www.drjoannaidorf.com/
Author with her books by Joan Naidorf
The book is available in paperback, electronic, and audio formats. The audio book was narrated by professional voice actor Susan Bennett. For non-medical folks who have a daughter, son, niece, or nephew in medicine or nursing who seems to be struggling, this book would make an excellent gift. It is so difficult to watch the discouragement of young people who have sacrificed so much and worked for many years to achieve the goal of an advanced medical or nursing degree.
There are some useful strategies that they can learn. Changing our entrenched negative ways of thinking is hard, but it is possible. It really makes a difference.
The clinicians can have the careers that they dreamed about. Our jobs are difficult, and the pile of disappointments grows larger. We can do so much better for ourselves and for our patients. I am three years in on the journey of publishing this book and preaching the message.
I am going to keep saying this and writing this because I know that one of you needs to hear it.
