I am having a tough week.

[meow1985]

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I've been in residency for 4 years and I still have excessive distress and self-blame whenever patients are nasty to me.

For instance, recently on call a CAP patient threw me out of the room saying that we didn't know each other so their safety was none of my business. I was rusty on my CAP legality of leaving AMA stuff so I kind of froze up. Not proud of myself there. And today I tried to set limits with a high-risk patient (strongly urged by multiple attendings to do so) and the patient fired me via a barrage of ad-hominem attacks.

Oh yeah, unrelated but I had to call CSP AND the police this week. Not fun. Triggering and upsetting.

I feel I should be better at letting this stuff roll off of me as part of doing business, but I'm not. I know "if you're not getting fired you're not doing something right," but I'm terrified of complaints as well as things patients say that strike at the core of my insecurities. I start to question my judgment and think maybe they're right.

I am not going to quit at this point, but I am having a hard time imagining it getting easier. This isn't a matter of residency or not residency. There will always be patients who don't do what the MD tells them, and who say mean or unreasonable things. And it's hard to imagine myself feeling emotionally safer under those circumstances.

 

[thepoopologist]

If you don't reflect on how to deal with similar interactions in the future, or if you aren't at peace with the fact that you will have insecurities and they are a work in progress, it will not get easier. Its time to forgive yourself and do better next time

 

[thepoopologist]

 

[WisNeuro]

Gonna have to get used to the patient complaints and occasional calls from patient advocate, especially if you work with Axis II or other patients with higher rates of exaggeration and/or malingering. Also, remember that for some, if not many, of the people you will deal with that suffer from chronic and severe mental illness, that this has been formed and strengthened by years, if not decades of life circumstance, and personal interactions. That isn't going to get fixed over a few meetings with a provider, and in some cases, it doesn't matter what you do.

Compartmentalization is key if you work in MH, IMO. If this is not a natural thing for you, I'd strongly suggest working with someone for individual therapy/counseling. Preferably someone who has experience working with MH professionals. As colleagues for references if you are comfortable, if you are not, your state psychiatry or psychology association may have a list. We keep a members only list of people who do therapy with people in the MH field.

 

[Monocles]

When I was an intern they assigned a group of us to shadow this world-famous attending who was like the protege of Gunderson and Linehan or something famous like that. We watch her interview this patient, who within 10 minutes of the interview gets up and says "UGH you're not listening at all" and gets up and walks out. That attending was completely stunned. It was awkward as hell, but it goes to show it happens to the best of us.

OP maybe to some extent your self-worth is tied up to your performance as a physician. If you instead think of it like any other customer service job and understand that some people may be difficult despite your best efforts, you might not take it as personally. :\

 

[TexasPhysician]

Consider talking to a counselor. This isn’t about being a psychiatrist, physician, or sanitation engineer. This is every job. You can’t escape a customer, client, patient, manager, boss, etc eventually criticizing your work.

 

[whopper]

Having more empathy makes you more vulnerable. A huge irony cause we're supposed to have empathy, yet we also often times deal with difficult patients.

 

[Mass Effect]

Oh yeah, unrelated but I had to call CSP AND the police this week. Not fun. Triggering and upsetting.

Triggering on a personal level? Because if so, this is something you should seriously consider working on ASAP. These cases will come up again and the only way to handle them well is to protect yourself emotionally.

 

[whopper]

In most places I've worked my colleagues have told me they thought I handled things very well with very difficult patients. Well that may be, but I noticed I've had specific behavioral patterns where certain types of patients still get under my skin.

I've noticed they come in specific algorithmic patterns. I also noticed that after I was able to ID those patterns I was able to come up with proactive strategies to deal with them before they got me too ticked off and entered emotional-blow-up territory.

Despite the above, yes it still happens. Happens less but still happens, and the fact that it happens less can make the sting even more so cause I pent myself up to a false sense of invulnerability.

 

[Merovinge]

In most places I've worked my colleagues have told me they thought I handled things very well with very difficult patients. Well that may be, but I noticed I've had specific behavioral patterns where certain types of patients still get under my skin.

I've noticed they come in specific algorithmic patterns. I also noticed that after I was able to ID those patterns I was able to come up with proactive strategies to deal with them before they got me too ticked off and entered emotional-blow-up territory.

Despite the above, yes it still happens. Happens less but still happens, and the fact that it happens less can make the sting even more so cause I pent myself up to a false sense of invulnerability.

Completely agree, it's a huge help if you already recognize when an encounter is likely to go south due to personality disorders, some types of psychosis, people who have hopped through lots of doctor's, "VIPs", etc.. The VA cocaine use disorder, severe, frequent flyer who threatened to wait till I leave to gut me is far less disconcerting than an upset parent who had been very appreciative of your services to that point. You can definitely learn from these cases, I know I tend to smile when things get particularly hairy (terrible reflex) so I pay particular attention to my facial muscles in these situations.

 

[cara susanna]

I suggest CBT techniques. For instance, catch yourself when engaging in emotional reasoning and remember that feeling guilty is not proof of wrongdoing. Generate alternative thoughts that are more helpful and, likely, more accurate. Exposure also works well - my supervisor once had me listen to an angry voicemail from a patient repeatedly until it bothered me less.

Most importantly, remind yourself that you're trying your best - and don't work harder than the patient. Remember that a patient's anger is not reflective of you or the work that you're doing. Sometimes patients get angry with us even though they're angry about other things.

Also, process and seek consultation. Whenever I have a rough experience with a patient, I stop by a colleague's office and get support. We're all in this together.

 

[Nines]

This is something that I’ve struggled with as well, though I would say that working on an acute inpatient unit with primarily involuntary patients has helped somewhat just by the fact that being yelled at, insulted etc is a very common occurance. But yeah, for those of us who tend to be agreeable and perhaps to an extent tending towards being “people pleasers” these interactions and confrontations can be difficult. What I’ve found helpful is trying to intellectualize the interaction somewhat. Like, if a patient acts out or lashes out in some way and your tendency is to take the insult or criticism to heart you could try to reframe it as a manifistation of their disorder. Challenge the automatic thought of “they’re mad at me so maybe I really do suck and I’m a terrible doctor” with the alternative of “this patient with BPD is acting out because I set limits, which is a good and appropriate intervention for this patient, it isn’t personal.” It does help with practice. I’ve found that there are some who can do this naturally but for me its required some work.

 

[deleted480308]

Sometimes being fired by a patient is a gift from the universe. You are responsible for your actions, not theirs

 

[futuredo32]

I am a huge supporter of psychotherapy. I am in psychoanalysis (it's eclectic therapy but 5x a week) and it is so helpful.

 

[PikminOC]

I am a huge supporter of psychotherapy. I am in psychoanalysis (it's eclectic therapy but 5x a week) and it is so helpful.

Five times a week? How do u have the time

 

[keolu hills]

Sometimes being fired by a patient is a gift from the universe. You are responsible for your actions, not theirs

Sometimes when patients get terminated they may be saying the same thing about us or when they fire us: "Yeaaaa I'm running for the hills." Iv'e noticed especially in psychiatry some of the docs agree with the patients. Some will even gossip with the patients if they know the doctor being gossiped about. I witnessed this when I took a very dear friend to see one. I was shocked!!!

 

[deleted480308]

Sometimes when patients get terminated they may be saying the same thing about us or when they fire us: "Yeaaaa I'm running for the hills." Iv'e noticed especially in psychiatry some of the docs agree with the patients. Some will even gossip with the patients if they know the doctor being gossiped about. I witnessed this when I took a very dear friend to see one. I was shocked!!!

They can gossip on the way out door. Buh bye

 

[the5thelement]

“This is the basic human story. We are all on the same journey. Every one of us will suffer—there’s no way around it. The crucial question is not how to avoid suffering, it’s how we move through it.”