Finding Empathy for Patients on a Difficult Day

I'm a little grumpy today. It was one of those days in clinic. Since it was the day after New Year's most specialty clinics were closed. Our office was open, so patients who had various symptoms and conditions managed by specialists were directed to our office. Our schedule maker forgot to schedule me a lunch break. The nurse's forwarded me messages that did not indicate a lot of critical thinking on their part. One patient who was fired by her psychiatrist informed me that both the psychiatrist's office and my office said that I would be able to take over prescribing her various controlled substances. It was the kind of day that made me wonder why anyone in their right mind would go into primary care.

In moments like these, I am faced with a choice. I can be ticked off for many good reasons. Or, I can rise above the frustrations and choose to be a physician. By nature of our profession, we are expected to make sacrifices. Today was hardly the only meal I've offered up for the sake of medicine. We are all recipients of patient "dumps" (which is a really unfortunate way to describe the care of a fellow human being). Our colleagues disappoint us. Our staff disappoints us. We disappoint ourselves. Medicine is hard work and each patient encounter requires your full attention, compassion, intellect, and skill.

Two of my patients today confessed that doctors didn't want to take care of them. One was a transplant recipient who is medically complex. Another was a chronic pain patient who needed a narcotic refill. The sad part is sometimes I'm that doctor. I sometimes do get frustrated and impatient and overwhelmed. That manifests as frustration and impatience with my patients. They can feel it.

In those moments when I know I am not at my best, I try to remember that I have to peer behind the veil that shrouds my patients. Many of the most difficult patients have a wall built of years of feeling uncared for, unwell, and hopeless. When we encounter them, it is off-putting. They may not be grateful or appreciative, and earning their trust is often built bit by bit over years.

With one patient encounter today, I reached inside myself for that last measure of compassion and drew it out for the young woman who sat across from me with suspicious eyes. Instead of getting frustrated with her requests and seemingly unsolvable medical problems, I stopped to consider her. Not her as a patient, but her as a human being and mother and wife. I thought about being in pain and having young children to care for. I considered what it would be like to go to the emergency department - sometimes the last hope patients have - and feel judged and like help would not come. Instead of getting overwhelmed that after a multi-specialty extensive evaluation, there was still no diagnosis, I attempted to feel empathy for what it must feel like to experience that evaluation and have no answers.

I could not solve her problem. It will take additional expertise and time to find the right diagnosis and treatment.  However, my hope is the same I have for all of my patients - that in the midst of suffering, worry, and illness, I can cure sometimes but care always no matter what kind of day I'm having.