#31 I Wrote a Good Book, but Don’t Just Take My Word for It

During the Covid year when I was reading, writing and teaching virtual lessons to residents online, I decided to take one of my topics and write a book. I sent it to the publisher at the American Association for Physician Leadership and I was offered a contract to publish the book.  In January of 2022, Changing How we think About Difficult Patients: a Guide for Physicians and Healthcare Professionals was launched.

As a relative unknown, promotion of the book has been a bit of a slog. I have asked total strangers to read it and gotten no replies from most. But several of the people I sent the books to have written and reflected and reviewed in the kindest ways.  I would like to share a few.

Jennifer Lycette MD is an oncologist, award-winning essayist (Kay Snow Award recipient 2021), narrative medicine chronicler, regular contributor to Medscape Blogs (2021-current) and Doximity’s Op-Med (2018-2021). On Medscape, Jennifer included these reflections on Brene Brown’s book Atlas of the Heart and my book as she wrote about the resentment she feels towards some of her patients. You can read the whole piece here or this short excerpt:

“It so happens that around this same time, I was reading another excellent book, Changing How We Think About Difficult Patients: A Guide for Physicians and Healthcare Professionals, by Joan Naidorf, DO.

Dr Naidorf is an emergency medicine physician of 30 years who wrote the book to "provide insight and tools to manage our negative thoughts about difficult patients" and help "beleaguered colleagues…return to their benevolent guiding principles and find more enjoyment in their vitally important careers."

As I read Dr Naidorf's book, I thus did so with the mindset of wanting to further understand for myself where this specific emotion of resentment toward our "difficult" patients could come from and how to best understand it in order to get past it.

Naidorf writes, "Challenging patients will never stop appearing… You cannot change them or control them—the only person you can control is you."

I wondered how much the resentment we might involuntarily feel at being asked to see a "difficult" patient has nothing to do with the patient but everything to do with it making us feel not in control of the situation.

Naidorf also writes, "Negative thoughts about challenging patients can cause, in otherwise capable clinicians, a sense of inadequacy and incompetence."

Do we perhaps resent our challenging patients because of the negative thoughts they sometimes trigger in us? If so, how does this relate to envy, as Dr Brown asserts resentment is tied to? Is it triggering us to feel inadequate?

"[Difficult patients] often make us question ourselves," Naidorf writes, "and we need to feel comfortable with the answers."

Again, the discrepancy between expectations and reality creates the negative emotion.

Or, as Naidorf writes, "What if you could stop judging others so harshly and accept them exactly as they are?"

Hmmm, I thought, then the cessation of harsh judgment and implementation of acceptance would have to apply to us too. The elusive concept of self-compassion.

Maybe the resentment/envy comes from us not allowing ourselves to behave in this way because to do so would allow too much vulnerability. Something most of us were conditioned to avoid to survive medical training.

Dr Brown also writes about an "aha" moment she had in her struggle to understand resentment. "I'm not mad because you're resting. I'm mad because I'm so bone tired and I want to rest. But, unlike you, I'm going to pretend that I don't need to."

I felt all too seen in that passage. Could it be my old nemesis, perfectionism, creeping its way back in? Is resentment the ugly stepsister to perfectionism?

Perhaps challenging patients can engender resentment because they make us feel like we're not living up to our own unrealistic expectations. And in that case, we need to change our unrealistic expectations for ourselves.

Dr Naidorf's book explores much more on the complex matter of what makes a "difficult" patient, but I chose to focus here only on the resentment piece as a tie-in to Dr Brown's book. I highly recommend both books for further reading to help physicians and nurses navigate the complex emotions our jobs can trigger.

Most importantly, recognizing that we have these transient negative emotions does not make us bad people or healthcare professionals. It only makes us human.”

Thank you Dr. Lycette for sharing an honest and insightful reflection.  Another lovely note came from Adam Lalley MD, who is an emergency medicine resident in Brooklyn as well as an avid reader and writer. He gave me his permission to share what he wrote.

“I've just finished reading your book, and I enjoyed it so much that I found myself trying to stretch it out. I rationed out a chapter each morning before my shifts in the Emergency Department, and I may have to read from them, and in them, again. Busy New York City Emergency Departments are hard, as I'm sure you know, and your book had a very effective blend of empathy, pragmatism and empowerment that I hope will shape my view of patients and of myself as a doctor for the rest of my career.”

I have been very happy to get nice feedback from people outside the medical profession and in other patient care fields. A kind reviewer, who I do not know, placed this review on the Amazon site for the book.

“I am a physical therapist and still found this book incredibly helpful. Working through COVID, and dealing with heightened patient emotions after, left me feeling burnt out and frustrated a lot of the time. After reading this book it changed my outlook on patient care and how my own emotions can make encounters worse. I decided to shift away from the victim mentality and my mood at work has shifted.

I don’t generally read books and I finished this within a week. Highly recommended to healthcare providers. I’ve already been telling a lot of my coworkers to read this.”

Thanks to many people who have been reading the book and sharing the message with friends and co-workers. Placing an honest review online is a lovely gift to any author or podcaster. I truly appreciate the time and effort reviewers give. I also review and rate as many books and podcasts as I can. The good favor comes back around.