October 23, 2011

the 'difficult patient'

as those of you who have followed this blog know, in august i started my clinical internship in inpatient oncology. while i've been dabbling in the outpatient setting, this has been my first true immersion in the fast paced, multi-disciplinary medical setting that is inpatient work. and, since the first day, something has really stood out...that there seems to be a troubling habit of using the phrase 'difficult patient'. as a social work intern, i have the honor and privilege of being referred to most of those 'difficult patients'...and, almost always, they are my absolute favorite patients. while i could tell you all of the reasons these individuals are particularly endearing, the point i want to make is that there really is no such thing as a 'difficult patient', just difficult situations.

there are many reasons patients develop 'difficult' behaviors...fear, lack of understanding, exhaustion, fear, a traumatic history, and in the case of cancer patients...fear. imagine, for a moment (and if you've had cancer, this will be an easy exercise), being brought to the hospital suspecting you have a cyst only to go into surgery and find out your body is covered with tumors from your metastatic pancreatic cancer and you only have six months to live. or, being driven six hours by ambulance from a rural town to a city hospital, with no family or friends (and no way to contact them), being told you have a cancerous tumor and need to make a decision to consent to surgery, even though your intellectual capacity doesn't allow you to fully understand what's happening to you. might you be frightened? want more time to talk to your doctor and understand? want the whole world to slow down while you come to terms with what you're being told? me too.

let's face it...being diagnosed with cancer (or any other illness, i'm sure) is traumatic, and none of us are truly prepared to deal with it. some people are fortunate to have resources to utilize during these times. personally, as a patient, i had the luxury of time (my diagnosis took almost two months), supportive doctors who spent all the time with me i needed, the support of family and friends, and a graduate level education to help me understand and engage in decision making. i know these things, especially in combination, are uncommon. take away any, or all, of these things and i, too, may have been a 'difficult patient' (and my doctors may argue i was...i did refuse necessary surgery for a good couple weeks). and, let me assure you, i did everything in my power to be a 'good patient' - sometimes at the cost of not asking the questions i had, expressing my hesitations, or telling people how crappy i really did feel (i had the 'easy' chemo, and the 'good cancer' after all) for fear of being seen in any negative light.

when we are able to put ourselves in these patients' shoes for just a moment, we may be able to empathize enough to hold short of telling our colleagues that the patient in whatever room is 'difficult'. i know that medical professionals are overworked, and trying in their own ways to survive the really intense nature of their work (perhaps especially in oncology), often by using humor or even detaching completely from patients. i get it, we all need to get through the day, and i'm not going to pretend i'm never guilty of getting really frustrated with a patient and not being able to give it everything i've got. all i'm saying is that, perhaps, we all owe it to our patients to change our language just a bit. we don't even have to eradicate the word, just apply it to what it really is...a difficult situation, not a difficult patient.

because one day, we too might just find ourselves in the midst of a diagnosis, totally overwhelmed with fear, wishing time would stop and decisions would come easy...and at that moment, i bet we would appreciate if we're not treated as difficult patients, but wonderful people in a very difficult situation.


  1. trust your 'gut'...always! knowledge is good, theories and paradigms for practice are okay...but in the end it is our hearts and souls which lead us to be good social work practitioners. i can say that as a clinical social worker of 31 years and someone who is surviving breast cancer. i work as part of an inpatient palliative care team. i am proud of you!

  2. So eloquently stated! I love your writing, Grace. It sounds like really great work you are doing. Your perspective is enriched by your own experience, I'm sure. It is neat to see you making the best out of your experience. I hope to do the same! Good job!

  3. Hello Grace

    I am so glad I found this posting via a very enlighting comment you made on forums.lymphoma:

    "Of course I discussed every choice with my doctor - I had to, he wrote the orders. That said, when it's our body that's being assaulted, we have every right to find information in any way we can and bring it to our doctor to challenge his or her decisions. Doctors aren't perfect, they are human...and the best doctors I have met appreciate having the patient involved in their own decision making.

    So, no, I don't agree that the doctor can best advise you. It's when the patient and doctor come together to direct decision making that the ideal path is taken."

    As a Hodgkin's survivor who had an extremely negative experience with an impatient doctor, who disliked being challenged so much, that he decided to dump me midway through treatment, not to mention labelling me "a difficult patient, with an argumentative nature" - I find it absolutely refreshing to hear someone else say exactly what I was thinking all along...there is no such thing as a difficult patient - only a diffucult situation!

    Many Thanks:)

  4. I have to agree that there is no such as difficult patient. Doctors should be aware that their patients are suffering with any illness or diseases and they are easily get irritated or stressed out. Doctors must be the one to adjust to their clients needs, well of course patients must do the same thing. and yeah, again there is no difficult patient just a difficult situation to deal with.

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