Hiding emotions in front of patients

[Sophie]

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We have standardized patient workshops every now and then to expose us to different types of patients. Last time was the anxious patient, today was the difficult patient, and next time is the dying patient. I did fine with the anxious patient, and am not too worried about the dying patient, but today was a complete mess. The patient screamed at, and verbally attacked, me for a good 20 minutes straight, no matter what I did. Near the end of this I got so frustrated that I cried.

I realize that we will have patients like this throughout our careers, and I'd really like to avoid crying the next time I'm in a situation like this. I obviously realized at the time that it wasn't a good idea to cry, and tried very hard to stop myself from doing it, but I couldn't help it.

And I already know I'm a wuss, or crybaby, or whatever, so you don't have to post if you just want to tell me that. If anyone has any tips to offer, however, I would be very appreciative.

Thank you. 🙁

 

[Law2Doc]

We have standardized patient workshops every now and then to expose us to different types of patients. Last time was the anxious patient, today was the difficult patient, and next time is the dying patient. I did fine with the anxious patient, and am not too worried about the dying patient, but today was a complete mess. The patient screamed at, and verbally attacked, me for a good 20 minutes straight, no matter what I did. Near the end of this I got so frustrated that I cried.

I realize that we will have patients like this throughout our careers, and I'd really like to avoid crying the next time I'm in a situation like this. I obviously realized at the time that it wasn't a good idea to cry, and tried very hard to stop myself from doing it, but I couldn't help it.

And I already know I'm a wuss, or crybaby, or whatever, so you don't have to post if you just want to tell me that. If anyone has any tips to offer, however, I would be very appreciative.

Thank you. 🙁

After seeing enough patients like this, you will become a bit more desensitized. Not always a good thing, but it will happen.

 

[Gut Shot]

We have standardized patient workshops every now and then to expose us to different types of patients. Last time was the anxious patient, today was the difficult patient, and next time is the dying patient. I did fine with the anxious patient, and am not too worried about the dying patient, but today was a complete mess. The patient screamed at, and verbally attacked, me for a good 20 minutes straight, no matter what I did. Near the end of this I got so frustrated that I cried.

I realize that we will have patients like this throughout our careers, and I'd really like to avoid crying the next time I'm in a situation like this. I obviously realized at the time that it wasn't a good idea to cry, and tried very hard to stop myself from doing it, but I couldn't help it.

And I already know I'm a wuss, or crybaby, or whatever, so you don't have to post if you just want to tell me that. If anyone has any tips to offer, however, I would be very appreciative.

Thank you. 🙁

In the real world you wouldn't put up with that for 20 minutes. You'd politely bail out and offer to resume under calmer circumstances. To force you to endure that is ******ed and mildy sadistic. What were they hoping you'd learn? That patients can be rude dinguses?

The first time I saw a patient try to get verbally abusive was in clinic with my surgery chief, and he just cut her off with "Clearly we can't talk about this right now. Let the nurse know if you'd like to try again while you're here. Otherwise make a new appointment." She suddenly became quite conciliatory.

 

[Psycho Doctor]

After seeing enough patients like this, you will become a bit more desensitized. Not always a good thing, but it will happen.

just don't become too desensitized; keep a good balance.

 

[RxnMan]

In the real world you wouldn't put up with that for 20 minutes. You'd politely bail out and offer to resume under calmer circumstances. To force you to endure that is ******ed and mildy sadistic. What were they hoping you'd learn? That patients can be rude dinguses?...

I agree. I saw tons of abusive patients in the ED is volunteered at, I even had my life threatened once, and I wouldn't put up with this crap. Though, if I was forced into it without knowing I could leave as was probably the case here, I'd have a hard time not responding either.

Don't feel bad - it was the proctor's screw up, not yours. It's school, not torture. If the patient checks out, you can check out.

 

[YouDontKnowJack]

it would help if you could picture your screaming patient as a piece of dog sh**.

 

[Ypo.]

We have standardized patient workshops every now and then to expose us to different types of patients. Last time was the anxious patient, today was the difficult patient, and next time is the dying patient. I did fine with the anxious patient, and am not too worried about the dying patient, but today was a complete mess. The patient screamed at, and verbally attacked, me for a good 20 minutes straight, no matter what I did. Near the end of this I got so frustrated that I cried.

I realize that we will have patients like this throughout our careers, and I'd really like to avoid crying the next time I'm in a situation like this. I obviously realized at the time that it wasn't a good idea to cry, and tried very hard to stop myself from doing it, but I couldn't help it.

And I already know I'm a wuss, or crybaby, or whatever, so you don't have to post if you just want to tell me that. If anyone has any tips to offer, however, I would be very appreciative.

Thank you. 🙁

WOW!!!!! That is SO much worse than our standardized patients (ours our usually noncommittal and aren't very forthcoming with information). I'm so sorry that you had such a hard time...I'm sure that developing a thick skin and remaining calm is a skill you will develop and learn with time.

I need practice at it too (but not for being screamed at, I've had plenty of experience with that after caring for borderline patients for a year). My problem was today I had a 375 pound simulated patient and as I was going thru the ROS, I asked her about appetite to which she replied "I hardly eat a thing". An astute person would have picked the double take that registered across my face no matter how I tried to hide it. It's hard...

 

[Pythagoras]

It is fake...lol

I don't understand why you started crying.

You should have just said exactly what the above poster said his chief did.

 

[robh]

We have standardized patient workshops every now and then to expose us to different types of patients. Last time was the anxious patient, today was the difficult patient, and next time is the dying patient. I did fine with the anxious patient, and am not too worried about the dying patient, but today was a complete mess. The patient screamed at, and verbally attacked, me for a good 20 minutes straight, no matter what I did. Near the end of this I got so frustrated that I cried.

I realize that we will have patients like this throughout our careers, and I'd really like to avoid crying the next time I'm in a situation like this. I obviously realized at the time that it wasn't a good idea to cry, and tried very hard to stop myself from doing it, but I couldn't help it.

And I already know I'm a wuss, or crybaby, or whatever, so you don't have to post if you just want to tell me that. If anyone has any tips to offer, however, I would be very appreciative.

Thank you. 🙁

This is an interesting situation. I am curious what they (your instructors) were trying to teach you. They put you in a contrived situation that would not exist in real life, that is you are being evaluated on your performance with this "patient" and didn't feel like you could shut the patient down by terminating (or threatening to terminate) the interview. I suspect that is what they wanted you to do, but I also suspect you didn't see that as an option.

My advice, do not allow yourself to be abused by patients. First don't take the bait and shout back. In real life if a patient becomes verbally abusive, explain that the visit will be terminated, if he/she doesn't stop the abuse. If it continues, leave the room and call security to escort the patient out. I also suggest that you talk with your clinical instructor about what happened and understand what his (or her) expectations are.

Try not to feel too bad about this. There is nothing wrong with you. You are not a wuss. You will find your balance. Hopefully it will be closer to where you are today than hard-bitten and insensate.

 

[SLPI]

agreed with the above poster about what his surgery chief did. standardized patient or real patient you should not have to put up with this. take control of the situation and tell the patient to either calm down or you will stop the history. this seems like a completely pointless excercise especially for M1s - the standardized patient sessions are supposed to make you feel more confident in taking the history.

 

[bjackrian]

I also suggest that you talk with your clinical instructor about what happened and understand what his (or her) expectations are.

This strikes me as excellent advice. If you know what they want you to get out of the experience, you may be able to handle it better. After all, this is supposed to be a learning experience! 👍

 

[Hodad]

Difficult patients need to be shown authority and discipline. They need to be put in their place as if they were spoilt children. I've had to deal with several in an ER context, and once you give them a few stern words they're (generally) as meek as lambs.

 

[stoic]

(edit: read the post above this one. that's what it usually boils down to)



In real life, the vast majority of patients who generate strong emotions on your part will be patients that piss you off because they are demanding, insulting, rude. You'll learn to deal with those patients... Everyone ends up with their own style. As you work with different clinicians you will see a lot of different approaches and you will pick and choose from those tactics to form your own. My preceptor is awesome and one of the things she does is purposely make me see those patients instead of sore throats and sniffles. I remember the first "difficult" patient she made me see. It was about 3 months into first year and I walked into the room with a patient who had a LIST of 7 items she was pissed off about from her last visit! I was fairly sure she added #8 on as having to talk to a med student . Mostly it had to do with wanting percocet and darvocet. And interestingly enough, also a flu shot.

My advice would be that you can't let the balance of power slip too much; I'd imagine that the standardized patients were trained to take it as far as you would let them. I think it helps to set an agenda with all patients at the beginning of the visit, but especially with "difficult" patients. Find out what they want to address while they're in the office. For a 15 or 20 minute visit, it's hard to do more than 3 or so complaints (sometimes fewer, depending on the complexity). So at the get-go, have the patient decide which concerns to address at that visit and stick to those issues. I'm sure you've heard all that from lecture before. Anyway, if a patient especially hateful, I honestly don't think there's anything wrong with stopping and saying "I understand you're upset, these are some difficult issues; But if you won't work with me, I can't help you." If they won't settle down, then ask them to reseschedule at a later time when they are less emotional and don't be afraid to end an office visit if the patient is too emotional to make and progress. (That actually applies to end of life situations, too.)

Don't ever get mad or upset in front of a patient - doing so reinforces their behavior and takes you down to their level.

The bottom line is that these are the patients that should take 10 or 15 minutes, but if you aren't careful, will take 30 or 45. You have to learn how to control the situation; otherwise you cannot gather the information needed.

 

[Pemulis]

All of the advice above about taking control of the situation and setting some boundaries is good. I'd add a different perspective too: part of our job as (future) healthcare providers is to deal with the emotional complexities of patients. There are going to be an awful lot of situations in which we can't do much for our patients except to provide them with some sense of emotional comfort. For example, the pt with the benign but idopathic symptom may simply need assurance that they aren't terminally ill; or the terminally ill patient may derive some sense of comfort from knowing that we're there to listen to them and to help in whatever way we can.

Anger is a part of the response to illness for many patients, and for some people, screaming at somebody for 20 minutes can be therapeutic. I'm not recommending that you tolerate that sort of abuse as a rule; but keep in mind that if a pt is being an a**hole to you, it's probably not personal, and you may in fact be helping them more than you can know to let them vent for a few minutes. Keeping this view in mind can go a long way toward preventing you from becoming emotionally caught up in the situation.

 

[hyperbaric]

The first time I saw a patient try to get verbally abusive was in clinic with my surgery chief, and he just cut her off with "Clearly we can't talk about this right now. Let the nurse know if you'd like to try again while you're here. Otherwise make a new appointment."

Good line. I'm filing this one away for future use. The difficult patients are coming.

 

[8744]

We have standardized patient workshops every now and then to expose us to different types of patients. Last time was the anxious patient, today was the difficult patient, and next time is the dying patient. I did fine with the anxious patient, and am not too worried about the dying patient, but today was a complete mess. The patient screamed at, and verbally attacked, me for a good 20 minutes straight, no matter what I did. Near the end of this I got so frustrated that I cried.

I realize that we will have patients like this throughout our careers, and I'd really like to avoid crying the next time I'm in a situation like this. I obviously realized at the time that it wasn't a good idea to cry, and tried very hard to stop myself from doing it, but I couldn't help it.

And I already know I'm a wuss, or crybaby, or whatever, so you don't have to post if you just want to tell me that. If anyone has any tips to offer, however, I would be very appreciative.

Thank you. 🙁

Don't worry. As a veteran of many standardized patient encounters including during residency at a certain large, Eastern academic medicine powerhouse which to avoid hard feelings all around I will refer to as "Earl," I can say with 100 percent certitude that you will never meet a real patient anything like the standardized ones.

Standardized patients are a joke. What exactly are they teaching you that you're a) not going to forget the first time you see a real patient, and b) you will learn for real the first time you see a real patient? I totally reject the current standardized patient paradigm.

The reason they always give us for having standardized patient exercises is because nice doctors don't get sued. True enough but I don't need to be taught to be nice. This is just one more way that lawyers have made many aspects of life a pain in the ass.

By the way, it is OK to show emotion to your patients as long as you're not too over-the-top.

 

[Sophie]

Thank you all for your responses, and tips. It's good to hear that a situation like that wouldn't happen in real life.

We actually get feedback immediately afterwards from our instructor. The instructor sits in the room with us and the patient, and the goal is to get a complete history from the patient and figure out what's on the patient's mind. With this past one we had to use the techniques we'd been taught regarding difficult patients (ie phrases like "It seems like you're ___, can you tell me why?", calm voice, don't argue back, understand why the patient is upset, etc). The instructor said I did fine with these, got a lot of info, had "kind eyes", a nice voice, and that if I hadn't cried it would've been a good interview. She didn't mention anything about taking charge, or telling the patient he had to either calm down or reschedule the appointment, or anything else mentioned here, but she did say this was a good experience for me to learn to toughen up.

Anyways, I really appreciate the posts, and have calmed down a bunch since yesterday, although I still think that's a really ****ty experience to put anyone through.

 

[dron000]

i think i'd be more afraid of crying when dealing with a dying patient... if someone is just angry for no reason, you know he's wrong and there is no reason to take it personally...

 

[DropkickMurphy]

just don't become too desensitized; keep a good balance.

Yes, it's never to get to the point where you start off delivering bad news with:
"You're agnostic right? Not for much longer you're not..."
"Have you ever wanted a good excuse to try BASE jumping? Well......"
"Want to bet $50 bucks that you won't be watching Dick Clark this New Year's Eve?"

 

[DropkickMurphy]

i think i'd be more afraid of crying when dealing with a dying patient... if someone is just angry for no reason, you know he's wrong and there is no reason to take it personally...

There's no reason to take it personally if someone is dying....unless you left a clamp in them.

 

[8744]

...and the goal is to get a complete history from the patient and figure out what's on the patient's mind...

The goal is to ellicit the chief complaint and get a good but succint history. What's on the patient's mind is usually (but not always) obvious from the chief complaint ("My back hurts," "There's blood coming out of my ass," etc) and there is thankfully usually no need to read their minds.

Some patients are kind of squirrely and have some secondary motive in which case it's not so much trying to find out what's on their mind as it is trying to see how they're trying to "play" you. Drug seekers are the best example of this. I wonder if they have standardized drug-seeking patients?

On the other hand you do need to relax around patients and learn how to make a little polite conversation, especially as this sets people at ease and makes it easier to ellicit the aforementioned history. But you aren't going to learn it on standardized patients. I was very easy-going with my standardized patients and was routinely criticised for making a few jokes here and there, like I do with my real patients.

I also don't take standardized patients very seriously and was once reprimanded for saying, "Mr. Smith, all I can say is if you see bright light, don't walk towards it."

 

[DropkickMurphy]

I also don't take standardized patients very seriously and was once reprimanded for saying, "Mr. Smith, all I can say is if you see bright light, don't walk towards it."

You seriously need to write a book or have your own TV show.....

 

[mjl1717]

We have standardized patient workshops every now and then to expose us to different types of patients. Last time was the anxious patient, today was the difficult patient, and next time is the dying patient. I did fine with the anxious patient, and am not too worried about the dying patient, but today was a complete mess. The patient screamed at, and verbally attacked, me for a good 20 minutes straight, no matter what I did. Near the end of this I got so frustrated that I cried.

I realize that we will have patients like this throughout our careers, and I'd really like to avoid crying the next time I'm in a situation like this. I obviously realized at the time that it wasn't a good idea to cry, and tried very hard to stop myself from doing it, but I couldn't help it.

And I already know I'm a wuss, or crybaby, or whatever, so you don't have to post if you just want to tell me that. If anyone has any tips to offer, however, I would be very appreciative.

Thank you. 🙁

Try to remember YOU are the professional in that room and no matter how good you are 1 out of maybe 100 or 1000 will be a bad apple.

By the way DropKick Murphy you are FUNNY!!

 

[soeagerun2or]

Near the end of this I got so frustrated that I cried. 🙁

Real doctors don't have emotions.

 

[Soup]

It was frowned upon when I told one not to buy green bananas.

 

[Law2Doc]

This is just one more way that lawyers have made many aspects of life a pain in the ass.

The decision for doctor to become nicer, befriend patients, own up to mistakes and the like, to avoid lawsuits actually originated from phsychologists and statistics, I believe, not the lawyers. 🙂

 

[njbmd]

I want to know where you found this photo of me and my intern? We thought we had destroyed all of the negatives!