The Temptation to Express Frustration with Patients

In my role as a physician leader, I was recently speaking with a patient about a complaint he lodged about his primary-care provider (PCP). Unfortunately, the patient had overheard his PCP speaking about him in a moment of frustration. The PCP is an awesome provider - caring, empathic, conscientious, and compassionate. However, he said some things during the course of a difficult day that were deeply hurtful to his patient. The comments the PCP made are the same type of comments both you and I have made dozens of times ourselves. We become upset with a patient who is chronically late or who claims that her pain pills accidentally got flushed down the toilet, again. Or maybe we feel helpless and powerless in the face of a patient for whom the diagnosis is uncertain and the treatment even more so. And sometimes, we're just having that kind of day - when we say things we regret about our patients, our nurses, our spouses, or our kids.

After apologizing on behalf of the PCP for the behavior the patient witnessed, I attempted to address the patient's deep hurt about the words spoken. I tried to explain that sometimes when physicians talk about patients, the words we use are a reflection of the frustration we feel with not being able to help the patient, rather than thinking poorly of the patient. Word of advice - this is not an effective strategy. Do not try it yourself. The patient retorted that this could not be the case as there was no way a provider who cared about him could've said the things he heard his provider say.

However, the truth is, as healthcare providers who hold a sacred trust with our patients to guard their secrets, their dignity, and their lives, we succumb to the temptation at times to vent our frustration about a patient to colleagues. In the past few years, I've made a conscious effort to avoid doing this with any clinical staff because I realized the way it was affecting the tone they used with our patients. Yet, I am still guilty of occasionally voicing things to a colleague that I would not want the patient to overhear.

This patient has changed my heart, not because I'm concerned about getting caught out if I am accidentally overheard by the target of my frustration, but because of the deeply felt hurt that this patient expressed. I realize it is a luxury we do not have, as healthcare providers, to unconsciously or carelessly let our words of frustration, anger, burnout, and fatigue be directed toward a patient. Not only can it be devastating to the patient-physician relationship, if the words are ever overheard, it colors the way we respond to the patient in countless unspoken ways.

As providers, we know the type of talk that occurs at the nurse's station, behind closed doors, or when unloading to a friend or colleague. It is traditional, it is acceptable, it is common, and it is wrong. I am guilty, just as many of you are probably guilty. For my part, I am committed to make my speech about a patient, whether in her presence or not, reflect the great care I have for her.