shitfm Posted February 12, 2021 Report Share Posted February 12, 2021 (edited) - Edited February 12, 2021 by shitfm deleted Quote Link to comment Share on other sites More sharing options...
Persephone Posted February 12, 2021 Report Share Posted February 12, 2021 If a patient is expressing frustrations to you that have nothing to do with you, the best thing you can do is acknowledge and validate them (it sounds like this has been really frustrating to try to get addressed/ I am so sorry this has been such a challenging process/I am so sorry you have been feeling this way/etc) and then try to centre on the patient's desired outcomes by eliciting them. Depending on the situation I might do that by asking, "what are you hoping for out of today's visit?", "is there anything you are hoping I can address?". If it's a situation where you are delivering a mgmt plan that a patient is disappointed by, you can start with, "Dr. XYZ discussed your case with me. Based on what you've been able to describe and what we've seen on physical exam, he thinks the likeliest diagnosis is xyz and the most appropriate treatment plan for that diagnosis is xyz. How does that sound to you?" You are asking this to give the patient a chance to express themselves. Then if they are disappointed/upset state, "I am sorry this isn't what you were hoping for. We should give this a try first, but if this plan doesn't end up helping please come back so we can try to figure out if maybe something else is going on or if there's something else we can do for you". Now if there are limitations to the available treatments and what they can do it's important to highlight that so that the patient's expectations are in line with what can actually be done. "This will likely not alleviate your symptoms completely, but what we hope is that it will make them more tolerable. We wish there was something that would completely alleviate the symptoms you're experiencing but unfortunately medicine just hasn't come that far yet. Hopefully this will increase your quality of life to some degree because we definitely don't want you to be suffering more than we can avoid." I hope this was helpful! I find that sometimes explaining why we make the decisions we make to patients can help a bit, but some people are just going to leave disappointed or angry and that's okay if you've done your best to try to show you have their best interests at heart and that you've spent some time listening to their concerns. People can get really anxious when it comes to their health and that anxiety can manifest as anger towards the physician when they're not feeling well cared for. Try not to let the anger get in the way of being compassionate towards their anxiety. shitfm 1 Quote Link to comment Share on other sites More sharing options...
Tullius Posted February 12, 2021 Report Share Posted February 12, 2021 May I suggest first adjusting your approach? Your thread title assumes the patient doesn't like you, but have you considered that the situation may have absolutely nothing to do with you? What you are describing sounds like the patient is unhappy with the situation they are faced with, their condition, and the system which hasn't worked well for them to this point. It's not personal. None of those things has to do with you. Personally, I find it effective to speak to these patients in a candid, no bullsh!t way. Skip the platitudes and validating statements that they've heard so many times as to become meaningless. Drop the doctor act and just be real with them. Be honest about what the system lets you do and not do for them, to manage their expectations up front. Be yourself. There are a lot of patients who will see right through the fake-ass healthcare provider lines, so if your manner is significantly different from everyone they've spoken to before, that may help them see you as a different person who is going to honestly look at their problem list with fresh eyes, rather than as another appendage of the same health care machine that has been letting them down all week, all month, or all year. shitfm 1 Quote Link to comment Share on other sites More sharing options...
cookie_m Posted February 12, 2021 Report Share Posted February 12, 2021 Sometimes there is nothing you can do. Don't take it personally. No matter what you do for some patients they will be upset and won't like your plan. That being said, you get better at deescalating a situation with experience. I learned a lot just from watching residents and attendings. Are you early in your clinicals? Sometimes you have to take control of the situation by guiding the conversation. This I have discovered is important for a subset of patients. If you let them take control of the conversation, it's over. If you already know what they want it's easier. Educate them on why this isn't an option. They might not be happy with you for not prescribing antibiotics or percocet but most agree with your plan if you present it in a certain way. If they think they need antibiotics, ask them why. Explain why or why not. I usually try and shoot these requests down early in the conversations if I'm sure it won't be an option (eg. patient wants refill on percocet and I know my preceptor probably won't do it). Sometimes the conversation goes "I think it's highly unlikely that we will do x, but we can discuss it with Dr. x." Having them sit there waiting, knowing that what they want is unlikely (while you discuss with your preceptor), can be helpful. Have you done an ICU rotation (I know it's unlikely with covid)? I thought this was the best learning experience for deescalation and getting patients to come to a consensus. Sit in on like 5-6 family meetings with a bunch of different doctors and you'll see what every doctor's style is for dealing with disagreeing families. shitfm 1 Quote Link to comment Share on other sites More sharing options...
shitfm Posted February 12, 2021 Author Report Share Posted February 12, 2021 (edited) - Edited February 12, 2021 by shitfm deleted - privacy Quote Link to comment Share on other sites More sharing options...
cookie_m Posted February 12, 2021 Report Share Posted February 12, 2021 Preceptors are encouraging you to do some therapeutic listening so that when they get in the room, the patient has already done some major venting. Why do you think they send the med student in first? Some will take pity on you and say don't worry about this one, and some will send you in on purpose. It's a good lesson. 90% of the time it's easier to just listen to patients vent and it will be over and the patient will be happier. Some people might disagree with me but if the conversation is going nowhere I I totally interrupt patients. Therapeutic listening works, but beyond a couple minutes of venting, it does nothing for patient care (especially if you're slammed). You need to remind the patient that you're here to take care of them. "I'm sorry that you had that experience. Right now your health is my priority and I want to be able to take care of you. Can you tell me more about X" Just watch what your preceptors do and incorporate that. There are some patients that are difficult and you can usually tell a few minutes in. For these patients I recommend not asking them "How does this plan sound to you?" While it might sound like a good idea, they will use that as an invitation to spin circles around you, and argue with you. You get better at redirecting with time and it is a skill that you develop. You are the doctor. You present the options and they select from the menu that you have presented. Definitely invite them to share their thoughts about the plan and make it a collaborative effort. If they feel included in making the plan, they're likelier to acquiesce and agree with you. Example. I might start off with: "Has anyone ever discussed x with you?" Don't ask them if they like the plan when you know they don't, it's like you're insulting their intelligence. Instead ask "(do you think it's reasonable that we do this trial, and) if you don't see any improvements we can reevaluate. I really want to see how you're progressing so please come back to see me in 2 weeks." No matter how much time you take explaining your rationale they might not like it. Read the room and it's totally fine if they don't like you or your plan. The only thing that is concerning is that patients are yelling at you. It just might be your bad luck. Are you doing something to tick them off? I've never had that happen ever. Maybe in the ER, but even that doesn't last long when they realize I'm listening. Even if they don't like me, everyone has always been super respectful. As the med student, it's been my experience that you usually have the best rapport with patients because you can spend the most time with them. Quote Link to comment Share on other sites More sharing options...
shitfm Posted February 12, 2021 Author Report Share Posted February 12, 2021 (edited) - Edited February 12, 2021 by shitfm deleted - privacy Quote Link to comment Share on other sites More sharing options...
cookie_m Posted February 12, 2021 Report Share Posted February 12, 2021 Sounds like you're riling them up and you're being too hard on yourself. After they've said they're piece, it's time to move on. I made the mistake of riling them up once or twice at the very beginning of my clerkships. Don't ask them about these negative experiences unless you have a solution. I usually don't even address these things if it's something trivial. Emphasize that you want to take care of THEM. Doing things on the computer can make things difficult because you're right there are no nonverbal cues. Seems like you're a normal person and it isn't necessarily a problem with you. Don't let 2-3 bad experiences get you down and define you. Don't make it sound like you're reading off a script because you'll sound cold. Just be confident and the patients will treat you with respect. Remember that everyone starts from somewhere and I guarantee you that this is something that you learn to get better at. shitfm 1 Quote Link to comment Share on other sites More sharing options...
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