Sunday 30 April, 2006

Recognise that you may hate some patients

Posted in Advice, Emergency Dept., General Practice, Michael Tam, Wards at 17:42 by Michael Tam

Original article by: Michael Tam :: Printer friendly

I hate you...

Some patients will just
rub you up the wrong way

Most junior doctors have an upbeat and positive attitude when they start. However, before long you may discover that you dislike if not truly loathe some of the patients admitted under your care – no matter how much you try to “empathise” with their situation. Many doctors find this situation quite confronting and deal with it poorly. The most common response is denial and guilt; and though this may be “okay” for a patient in the Emergency Department who you will never have to see again, it is not a good framework for inpatients, especially if they are sicker or have chronic illnesses.

It is important to recognise to yourself when you don’t like someone as it is easy to fall into behaviours or conduct that is unprofessional, e.g., being rude or openly angry to the patient, minimising contact to such a degree that it impairs clinical judgement (i.e., taking a poor history or examination or giving inadequate information for a consent), or doing “punitive” blood tests or procedures.

When you start to feel some serious “negative counter-transference” it’s a good idea to take a moment and acknowledge it. Furthermore, you must reflect that “it’s okay” to hate some people. We are humans before we are doctors and it is natural for us as humans to not like some people. If you recognise and accept your emotional response, then it should be easier to perform in a professional manner.

A corollary of this is that some of your patients will hate you even if you’ve been nothing but courtesy incarnate. Don’t be particularly offended or upset and try not to take it too personally. It’s not your job to get everyone to like you and not everyone will. Some patients will be racists, be sexist, bigots or have a full blown antisocial personality disorder.

IT IS OKAY

  • for you to hate some patients;
  • for you to ask someone else to care for the patient if it is unbearable;
  • for some patients to hate you.

IT IS NOT OKAY

  • for you to act in an unprofessional manner or abuse patients;
  • for you to quietly turn into an emotional wreck and not ask for help;
  • for patients to be rude or abuse you.
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