The Hateful Patient

Craig R. Hildreth, MD

Lately I've been thinking about the fact that doctors don't get to choose their patients-all those who walk through your doorway become your responsibility, at least until you either cure them, satisfy them, or in the rare case of incorrigibles, banish them. Opening our office to all comers is part of every doctor's commitment to the sick, and the faster we accept this, the smoother our day will proceed. Sometimes, though, it ain't easy.

In real life, patient-doctor relationships do not mirror television dramas, replete with guilt-ridden stares, frenetic dashes down hallways, gasping confessions and tidy conclusions by the top of the hour. Building a successful bond with patients requires a significant if not tedious investment of time, mixed with empathy-oh, and when it comes to inspiring confidence it doesn't hurt to come up with the correct diagnosis too.

With this in mind I recall a medical school professor who warned us to be alert for what he termed the "hateful patient." We were surprised to learn that he meant not those patients who were angry, but those patients who incited us to anger, who for one reason or another upset us to the point where our emotions interfered with our duties. It's delightful to help sweet little old ladies figure out their blood pressure meds, but how do we cope with people who exasperate us? There are many examples: patients with inordinate demands (I'm sorry, I can't call all seven of your kids to debrief them at this time), or a blissful ignorance of the passage of time (while my waiting room overflows), or the dreaded quirk of not listening, or (all too frequently) a pervasive and unfortunately highly infectious attitude of disgruntlement. Combine any of these with the typical emotions patients feel when freshly diagnosed with cancer, wondering if the unthinkable could really happen, and no wonder folks get testy.

How should doctors deal with the "hateful patient?" How do they summon up the equanimity to handle their medical issues without getting steamed, or mentally abandoning these difficult people? Here are my answers:

1.) Cultivate a thick skin and don't take affronts from sick people personally-remember, you have been hired to fight disease, not make friends.

2.) Stick to the facts and ignore all distractions; keep the discussion focused on the goals of treatment.

3.) When all else fails, sit down, shut up and listen, just listen to these patients. Even if you find their complaints preposterous, try to empathize with them. Remember, all of us become patients at one time or another, and wouldn't we appreciate meeting someone who is actually interested in our story?

Whether I adore them or loathe them, in order to live up to my oath I must treat people the same-with the respect I myself would want to receive, with the dignity that every human life deserves, and with the understanding that just because someone is miserable, it doesn't mean you have to become miserable too. Don't let someone else's peculiarities hinder you from what you have been trained to do-instead, carry on in good faith. That is the definition of a professional.