You did nothing wrong. Patients will often get defensive and feel "judged" when they hear something they know is true, but are self conscious about it. This response is visceral, not rational. You are doing your job. We would actually be doing patients a disservice by telling them what they want to hear, instead of what they need to hear. At the end of the day, no one can please everyone. Move on.
These things happen all the time in medicine! What a safe place for that patient to be able to speak up and mention that she was uncomfortable. It may be worth asking to watch how your staff handles sensitive topics because there must be some stellar rapport (instead of the patient quietly feeling upset and not telling anyone/not coming back).
When it comes to potentially sensitive topics like weight, substance use, trauma etc. my approach generally is to ask if the patient wants to talk about it, and if not, then cool, mention you are there for them at any point, and move on with the visit. If they do want to talk, I ask a lot around what the patient expectations are and what they want to address about the sensitive topic. I find this helps me avoid putting my foot in my mouth (too much), and lets my patient know I’m a safe person to talk to when they have the time, energy, mindset etc.
In this case, what you could try differently next time is nutrition and exercise counselling specifically for their HTN. Make it clear that reducing salt in the diet, using evidence-based nutrition choices can lower blood pressure (and if the weight changes it’s a welcome side effect for the BP). Moderate exercise of 150+ minutes a week can reduce BP. I would guess making the same suggestions with lowering the patient’s weight as a goal is what made them uncomfortable in this case.
You did what you should do (and above and beyond), and I think you did a commendable job as a physician. You could've just wrote them a script for Norvasc, tell them how great their hair look today and leave the room, but you actually did more than that.
You shouldn't feel horrible at all. I've met countless people who's got their "head up their ***", borrowing from Gordon. Like they say, "you can't wake up someone who's pretending to sleep". If the patient/family is in denial, then yes, try to wake them up (which you did), but in the end, let them do what they want to do.
They never teach you this in med school but let me tell you this, don't tax yourself for 1 person at the expense of 99 others. You want to have energy and mental stigma to provide good care to your whole patient population. If you "kill your brain" over 1 or 2 outliers, then you are doing the 99% of your other patients a disfavor. You'll be burn out and they won't get good care. It's a balancing act. This "risk management strategy" stuff they never teach you in med school.
Contrary to the advice given above, I argue that ECs matter quite a lot. Competitive programs especially derm have a very large pool to select their interviewees (~80 people from which they can interview around 20-30 per school). There is a huge pressure to make 20+ publications, but a good number of individuals with <10 publications will end up matching. I know of at least one new derm resident who essentially had no research but very impressive ECs, with interviews all over Canada (late pivot to derm with no network). Have a look at the CaRMS pages for each respective school within the derm category, and their specific preferences i.e leadership, artistic qualities, etc..
Also, quite obvious, but ECs will give you some content to talk about during interviews.
Quoted the stuff that could possibly relevant. Essentially, for residency unless its spectacular or unique they don't care about anything that doesn't require you to be a doctor. IE volunteering that mattered for med school apps don't matter anymore. As the above poster says they want impressive/unique stuff relevant to your desired specialty. Stuff on diversity, ethics, equity, etc. is good, but will be secondary to stuff relevant to your specialty. The writing stuff would be relevant depending on where you write and what the audience is. Also they don't care if you applied for funding for research etc. unless it's a prestigious grant or you publish as an author.
Take every opportunity to listen to others when they talk to patients about sensitive topics. Ask your staff how they would have approached it. In my residency I learned something new every time I listened to my staff take a HEADSS history.
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