Why I'm Thankful for My Difficult Patients

Every practice has them ... you know who they are!  I have a whole bunch of them.  They are the patients who used to make me groan when I saw them on my schedule.  I secretly hoped that they wouldn't keep their appointments, and I dreaded when I finally had to go in that room. 

These are also the patients that insisted (and still do insist) on seeing only me, and I’m never sure that I answered their questions adequately or whether they received what they needed from me.

However, today I’m very grateful for these patients. Why? Because I have come to realize that they make me a better physician. 

I have two families in particular that come to mind when I think of what I used to call, “time sucking black holes.” Appointments with these families have always taken an inordinate amount of time.

I have taken care of the children from these families since they were infants.  The kids are terrific; it's the moms who are difficult for me.

I have spent extreme amounts of time in the exam rooms with these families, especially with their first children.  These moms were needy, asked endless questions (occasionally asking the same question in multiple ways), and usually seemed like they were not satisfied with my answers.  But they kept coming back to see me and no one else.  Often their questions were thinly disguised questions about themselves and their relationships with their children.

The first mother (I will call her Lara) now has four children, ranging in age from 17 years old down to 6 years old.  This mom works for a federal governmental agency that is very strict on its time-off policies.  Her third child has asthma, which in the past has been very severe.  I filled out an FMLA form for the mother, in case the child had a bad bout with his asthma. If you haven’t filled out an FMLA form, let me tell you it is an adventure!  There is, of course, no way to predict just when the child is going to be hospitalized or need follow-up appointments with specialists.  And this form must be filled out yearly.

Lara is always late for her children’s appointments and ALWAYS wants to talk about her difficulties with her job and her parents (who help with the kids when she is on night shift).  As long as I can keep focused on my patient (the child in the office) the appointments go much more smoothly.  I listen to her troubles, but don’t get bogged down in them.

My other challenging mother (I will call her Ruth) has three children now.  Her oldest has a diagnosis of autism spectrum, her middle child has significant gastrointestinal issues, and the youngest had cardiac surgery during the neonatal period. 

With her oldest child, the appointments were always very long (and at the time, we had no idea he was on the spectrum).  The front desk eventually just started booking double the amount of time for her. 
Ruth was insecure about whether she was doing a good job as a mother, and she second guessed both herself as well as my advice.  Her second child really was a handful (still is), and the third really put her mom through the ringer with his neonatal cardiac surgery.  (All the children are really thriving at this point, by the way.)

In the past, every time I saw Ruth’s or Lara’s children on the schedule, I just wanted to run out of the office.  I knew these would be long and often challenging office visits.  I started to ask myself, “Why me? Why can’t they go bother someone else?”  But they kept coming to see me.

Over the years I have gotten much better at dealing with both of these families (and many more of the same type).  Also, these particular two mothers seem more competent in their roles as mothers.  But the biggest revelation is that these difficult patients have made me better at my job.  I finally realized that I must be giving them something that is helpful to them and that’s why they keep coming to see me.

So I no longer dread the difficult patients that continually ask to see only me.  I know that I am helping them in some way (even if it is not obvious to me at the time).  I often have to direct the conversation a bit so we don’t get bogged down in triviality, but we get all the pertinent issues taken care of.

My aim in writing this article is to give thanks for my challenging patients.  They have taught me patience, humility and, most importantly, how to manage our time together.  They have indeed made me better at my job, have changed my perspective on patient care, and I wouldn’t trade them for the world!