Patience with the difficult patient

It was almost midnight when I saw a patient spit at a fellow resident. The patient was upset because of the time she had waited to be seen. Even though the physician explained the situation in a calm way, the patient left the emergency room (ER). The resident then cleaned his face, and we continued seeing more patients throughout the night.

How many times do we have to deal with “difficult” patients during our careers and our daily lives? In one of his meditations, Marcus Aurelius once said: “Because a thing is difficult for you, do not therefore suppose it to be beyond mortal power.”*

That same day, I had been in the ER seeing a patient with appendicitis. When I finished the examination, I went to talk to the patient’s parents and explained my diagnosis, prognosis, and treatment plan. Initially, all of this clinical information seemed to scare them. They thought their child only had a urinary tract infection, so they weren’t expecting surgery as a treatment plan. When I finished talking, the patient’s mother thanked me for my explanation and said she felt reassured.

I remember suturing a patient that attempted suicide by cutting her wrists; I did a subcuticular running suture. At the beginning, the patient was reluctant to accept treatment and talked sadly about life. After I finished suturing the patient, I listened very carefully to all the complaints she had regarding her situation. I truly believe that listening to her complaints helped out a lot. The patient was very grateful for the stitches and the way I took care of her. She told me that she was thankful because I had reconstructed a part of her body that she had destroyed and that I did it passionately.

Patience has its rewards

I have had my most rewarding experiences when my patients fully understand the diagnoses I give them. Sometimes the high volume of patients we see reduces the time we have to spend with each one of them. However, if we go the extra mile, use simple language, communicate diagnoses in a concise manner, and listen to patients’ questions carefully, we can maximize the use of this time and the care we provide. If we exert this extra effort of listening carefully and provide short, crisp, clear answers, the quantity of difficult patients will be reduced significantly.

Vincent Van Gogh said, “…As we advance in life it becomes more and more difficult, but in fighting the difficulties the inmost strength of the heart is developed.” We learn from our mistakes on a daily basis, and as we see and treat more patients, we will find the best way to manage the “difficult” ones. I think that every time we see a patient, we open a door to an encounter that will test our mind, knowledge, and passion for our career. And as George Bernard Shaw once said, “No man who is occupied in doing a very difficult thing, and doing it very well, ever loses his self-respect.”

*Aurelius M. Staniforth M, translator. Meditations. New York, NY: Penguin; 2005:64.
†Van Gogh V. Dear Theo: The Autobiography of Vincent Van Gogh. Irving Stone, Ed. New York NY: New American Library 1969:26.
‡Shaw GB. The Doctor’s Dilemma: Preface on Doctors. Available at: Accessed April 7, 2014.



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