As a brand new, third year medical student, I am continuously being bombarded with multiple emotions and am excited and eager to learn. In order to prepare for the upcoming years, many of us reach out to our knowledgeable upperclassmen. I remember most of our conversations being very similar. With the same nostalgic facial expression, upperclassman would say “you are in for the best and worst year of med school”. As my third week of clerkships begin, I too cannot help but to reflect on the rollercoaster that these past couple of weeks have been.
When I review my patient notes, there is a specific patient that I cannot stop thinking about, hereby called Jane Doe. Jane Doe, soon to be nicknamed “the difficult patient”, was admitted to the hospital for a presumed COPD exacerbation. Per my usual morning pre-rounds, I would check in with Jane’s designated nurse and follow up regarding any overnight events. Almost 99% of the time, I was told that “the difficult patient” was very irritable, very emotional, and did not want to speak with healthcare providers. Seeing how this was the beginning of my clerkship, I too was not confident that I could speak with this patient without being verbally attacked. Even so, I decided to go into the room and speak with “the difficult patient”. After performing my usual Dr. Moffitt H&P and physical exam, I noticed I had a few more minutes before rounds began; therefore I continued to ask questions in order to understand more of her story. She soon opened up to me and informed me about all the additional life stressors that had been upsetting her. She also began to update me regarding other medical concerns that were not previously documented.
Flash-forward a few weeks, I now think back to how her presumed COPD exacerbation could have been treated more effectively if the new information that I received was brought forth on her first day of admission. Then, I asked myself, what role do healthcare providers play in resolving patient-provider relationship turmoil? Is it more dependent on the patient, physician, nurse, technicians, or medical student? As a medical student, I had more time available to speak with Jane. During those few extra minutes of trying to get to know her story, I not only obtained additional pertinent health information, but I was also able to help reconcile the patient-provider relationship.
Our duty to patients involves justice and beneficence. Treating all people equally and equitably also refers to patient-physician relationship. By developing a strong and solid patient-physician relationship, implicit bias can be diminished and non-maleficence can be further promoted. Labeling Jane Doe as “the difficult patient” hindered non-maleficence because the label itself places medical discrepancies at the fault of the patient. Blaming the patient can potentially alter the physician’s treatment plan if the patient is seen as “difficult,” and thus “non-compliant”. Per my experience and research from the AMA Journal of Ethics, I gained the following points: As a medical student,
- I have the opportunity to interact with patients for a greater length of time.
- I can use my knowledge and time with the patient to listen and advocate.
- I can use my time to mediate patient-healthcare provider relationships.
- I have the opportunity to bring light to implicit bias.
It is important to keep in mind that biases, such as labeling a patient as “the difficult patient”, can impact judgment, perception, and ultimately medical care. The patient is at a vulnerable time in their lives where they feel as if they have limited control; therefore it is up to the healthcare providers (including the medical student) to foster healthy, trusting relationships in order to abide by the ethical obligation of “do no harm”.
- Do Physicians Have an Ethical Duty to Repair Relationships with So-Called “Difficult” Patients?.AMA Journal of Ethics. April 2017, Volume 19, Number 4: 323-331. doi: 10.1001/journalofethics.2017.19.4.ecas1-1704.
Nancy Lopez was born and raised in Los Angeles, California. She graduated from the University of California, Irvine, with a degree in biological sciences with a minor in medical anthropology. She received a Master's in global medicine from the University of Southern California. She has a special interest in rural and public health. In her free time, she enjoys dancing, hiking, snowboarding when the sunny Arizona weather is permitting, and spending time traveling.