#69 Reflection: When You Don’t Like Someone

I like to listen to podcasts when I am on walks and during long drives in the car. One of my favorites is Better than Happy with life coach Jody Moore. I am most certainly not in her target demographic, women of the LDS church, but I enjoy her podcast.  I find that her pleasant manner and the clear, folksy, articulation of her message resonates with me. Some weeks I skip. Last week, the topic of “When You Don’t Like Someone” piqued my interest.

Jody speaks about having dislike for people in our personal lives. I wrote a little book, Changing How we think about Difficult Patients, that covers a similar topic to help doctors, nurses and other clinicians cope with the challenging interactions we have with some of our patients or their family members. Sometimes the behaviors of our patients or their families is so aggressive, oppositional, and insulting that we feel frustration and dislike towards them. What can we do about it?

Art from American Association for Physician Leadership

In a very understandable way, Jody Moore tells her listeners to “own” their thoughts and to stop talking about them.  She also advises to refrain from self-judgement and shame about your negative thoughts, and to get curious as to why you are having them. Dr. Groves tried to tell physicians this in his classic 1978 article: Taking Care of the Hateful Patient. He said that the negative emotions that physicians have towards some patients offer useful clues that should not be ignored. His article is well worth reading but the jargon and message is not accessible for most people.

So. you may be a physician or nurse who finds that one of your patients skips half of his appointments, continues to smoke, and won’t take his blood pressure medication. When you see his name on the schedule of your daily appointments, you dread it. You anticipate a half hour of antagonism and discomfort.  Treating him makes you feel ineffective and inadequate as a professional. You don’t want to feel this way and you know that you shouldn’t. You feel some shame about disliking this person.

In the context of her podcast, Jody says, “You're just a human being who doesn't care for the way another human being is showing up in the world.” You need to own up that you are the one who is causing your own feelings with a whole host of thoughts like: He’s doing it wrong. He should be following my advice. This puts the focus on you and what you think and believe. You can’t control the patient who can’t make appointments, can’t stop smoking, or won’t take his medicines. He might just be doing the best that he can do in his life circumstances.

So what now? You are creating your own experience and believing that the “difficult” person should not be doing it that way only makes two people suffer. Ask questions to find out why.  What can they do? Where can they go?  Is he addicted to nicotine or in need of more support to quit smoking? Does he forget to take his medications or have side effects from the meds that he cannot tolerate? What will help them the most now in this current situation? Curiosity about the circumstances of his life will help you and the patient solve problems together.

Understand that you, the clinician, are also a human who feels frustrated, or angry, or defeated. We went in to our professions wanting our patients to comply and to respect our highly-educated opinions.  Did we really think that would happen all of the time? Did we believe we would get 100% compliance, smiles and handshakes of gratitude? That piece of magical thinking causes many of us to suffer needlessly.

 Should your patient place the highest priority on his office appointment to the detriment of his job or other obligations? Do you make your patient’s non-adherence to a medication regimen or a smoking cessation plan a reflection on your competence as a physician or nurse? Does his missed appointment mean he has no respect for you or your time?

It helps to remember that our patients, who are competent, have the autonomy to accept or refuse treatment offered by the physician. What they think or believe determines how they follow the plan as we set out for them.  It is worth getting curious and trying to find out why a patient or family member is acting in an unexpected or oppositional sort of way.

Do they have a prior bad experience with medical treatment that has left them traumatized? Some patients have medical PTSD symptoms with fear and anxiety that loom out of proportion to the situation at hand. Some people don’t even realize that they have these issues. Usually the  behavior we label as “difficult” makes some sort of sense to the person acting that way. If we can accept that, our challenging interactions with some humans will not seem quite as dramatic or unexpected.

Jody tosses out a very relatable and silly rhetorical question at the end of the podcast. It is probably just an afterthought when contemplating why people act the way that they do. She says, “Why do people have to act so peopley?” Indeed.  That’s what people do.