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Episode: Challenging Patients

Author: Michelle Chestovich MD
Duration: 00:12:46

Episode Shownotes

Physician coach Michelle Chestovich MD shares 2 simple strategies that can help these challenging encounters become a little easier.

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Full Transcript

00:00:00 Speaker_00
You are listening to Episode 190 of the Remind Yourself Podcast. Welcome to the Remind Yourself Podcast, the podcast for physician moms just like you who want to ditch mom guilt, stop yelling, and start enjoying their lives today.

00:00:21 Speaker_00
I'm your host, Michelle Chestovich, certified life coach, family physician, and mom of four. If you want to overcome overwhelm for once and for all, this is the place for you. Hello, Mama Docs, and welcome back.

00:00:39 Speaker_00
Today, I'm going to talk to you about something that I've been coaching on quite a bit lately, and I know that it will be helpful for all of you. And the topic today is going to be about challenging patients.

00:00:51 Speaker_00
I know we all have them on our schedule at various times. I know that it also contributes to a lot of the stress that we have day to day. And what I want to tell you today is that you are human.

00:01:05 Speaker_00
You are not a bad human because you get frustrated and judgmental of these patients.

00:01:10 Speaker_00
But I want to give you four tips that are going to make these interactions much easier, because as you well know, there are certain people that we see their name on our schedule and our heart sinks a little bit. Maybe we feel a little bit nauseous.

00:01:26 Speaker_00
Maybe we have dread. And for some of you, I hear that you even look ahead and that you have anticipatory dread for several days because you're going to be seeing this patient.

00:01:36 Speaker_00
And sometimes you see the patient and they fill you with such frustration and they take a lot of time and you're running behind. we start to make a big, huge story about these particular patients.

00:01:48 Speaker_00
And again, it contributes to the already challenges of our life as a physician. And I just want to make these challenging patients less so. OK, so we are going to start with number one.

00:02:02 Speaker_00
We are not going to become Pollyanna folks who just think everything's fine. I have to just always have the best mindset to deal with everyone. because that's not likely to happen.

00:02:14 Speaker_00
Yes, mindset matters, and having a better understanding of where your mindset is will make a difference for you, but I also want to be realistic that we as humans have thoughts and judgments, and that does not make you a horrible person.

00:02:28 Speaker_00
Because sometimes we layer on this extra guilt. Like I'm a physician, I'm supposed to like love all the people. And yes, it's true. You're going to take care of all the people.

00:02:38 Speaker_00
And it's also true that some humans, for whatever reason, are more challenging for us. OK, that's not a problem at all. And I'm not going to make it like, well, these are our best teachers. Like maybe that's true.

00:02:50 Speaker_00
And yet that's not going to help you have a smoother day. So I'm going to start with the first tip that will help you. And it's very simple. Number one. Drop the labels. Think about these people more objectively.

00:03:06 Speaker_00
Instead of thinking like, oh my gosh, this person's such a train wreck. They have so many complaints. They complain all the time. They're such an Eeyore. They don't do anything that I say, right?

00:03:16 Speaker_00
Like we have all this kind of big story that amplifies the already challenging patient. And so what I will say is just look at the patient more objectively. This is a 36-year-old female who has five chronic medical issues who's coming in today.

00:03:31 Speaker_00
That's it. See if that helps. Now again, does that make it like simple? No.

00:03:36 Speaker_00
But when you start to look at your patients who in the past have filled you with dread, when you start to look at it more objectively, I think that you will find that this does make a difference. Number two.

00:03:46 Speaker_00
When I ask physicians why it's so challenging with some of these patients, when I start asking, okay, why is that a problem? Why is that a problem? Oh, they come in with 10 different problems.

00:03:56 Speaker_00
They don't even answer one thing and they jump onto another. They never implement any of the things that I suggest. They're not getting any better.

00:04:05 Speaker_00
This is what I will tell you is that when I start digging a little bit more, many of us take that very personally. We think that somehow we should have a magic wand to just fix everyone.

00:04:16 Speaker_00
And so when there is somebody who's having difficulty, we often take that as a reflection on how we're doing as a physician. And so we just need to let that go.

00:04:27 Speaker_00
And just realize this is a human who clearly has a lot of struggles in their life and we can show up and help them the best that we can. Now, are we going to solve all of their problems and make them perfect like they would desire? No, absolutely not.

00:04:40 Speaker_00
We were going to be realistic. But when we remember this person is clearly struggling. with either their chronic medical conditions or their psychosocial issues or personality disorders. Who knows what it is?

00:04:53 Speaker_00
They are somehow struggling and you are going to show up and listen and help them. Again, not only looking at it objectively, but just realizing I can accept this human for who they are and I'm going to show up and help them the best I can.

00:05:08 Speaker_00
and also being realistic with yourself that you don't need to solve all the problems. Okay?

00:05:12 Speaker_00
Oftentimes, I hear that another reason that these quote-unquote challenging patients are so difficult is that they have so many issues and you're trying to do all the things and you're expanding all the time. You are the leader in the room.

00:05:26 Speaker_00
You're not a better human. This other human is a lovely human as well. But you need to be the leader. And if you have a 30 minute appointment with him, you need to right size it.

00:05:35 Speaker_00
Yes, they're going to have things that maybe would take an hour and that wouldn't even become half of it. But you need to say, OK, we have this much time together.

00:05:44 Speaker_00
and really set some good boundaries with the patients, negotiate with them and say, wow, sounds like you've got a lot of concerns today. These are the couple of things we're going to tackle.

00:05:52 Speaker_00
When you realize they're struggling and we know that we can direct them. That's not always the easiest thing to do because we want to fix everything, but we can't. OK, so you're going to remember they're struggling.

00:06:05 Speaker_00
I'm going to show up and listen, because here's the truth. Just listening to a human and all of their concerns or issues is a step of healing for them. To bear witness to someone's pain and suffering and frustrations in their life is healing.

00:06:21 Speaker_00
Again, most of us want the diagnosis and the treatment. That's how we think we've done a good job. Yes, that's awesome when we can do that. And sometimes it's much more challenging. So to listen to them and say, Wow, this is really tough.

00:06:35 Speaker_00
OK, now what can we try? What's one step that we can take in a direction to help you feel better? Also, I think at this point, it's helpful to see what are their goals?

00:06:47 Speaker_00
Okay, this is sort of an extra step that I'm just thinking about because we think we just need to always fix the problem and sometimes problems just can't be fixed. Maybe this is something that's lifelong for them.

00:06:57 Speaker_00
What is a goal that they have and how can we help them take one step in that direction to achieve that? The third thing that I want to remind you is that if they're seeming dissatisfied or unhappy, that's not because of you.

00:07:13 Speaker_00
We as humans personalize everything, and we physicians are really, really good at this. If someone says something, we take it very personally.

00:07:22 Speaker_00
If someone's upset because we don't have a solution to their problem, if they're upset because we can't deal with all of their issues today, if they're upset because we're running behind, if they're upset because we don't order that MRI or prescribe that particular medication,

00:07:36 Speaker_00
That's really about them. And this brings us back to the previous thing. We can just witness and see that this human is struggling and they're upset and that's okay. Doesn't mean that we're bad and it doesn't mean they're bad.

00:07:47 Speaker_00
That's just where they are right now. But when we can just realize like they're upset and it's not about me, we don't need to do all of the extra things to try to make them happy.

00:07:57 Speaker_00
Again, so many people take a lot of extra time with these challenging patients. They spend a lot of time messaging back and forth. Some people are unhappy and that's okay.

00:08:07 Speaker_00
Doesn't mean we don't try our best to help them, but sometimes we can tort ourself and do all of these things and people are still upset. It's not about you. It's what's going on in their mind and in their life.

00:08:19 Speaker_00
And the final thing that I want to say is that it's important for you to self validate how you're doing as a physician. on the regular. We're so used to external validation, getting all the gold stars and all the A's throughout our life.

00:08:35 Speaker_00
And now that we're out taking care of patients, patients like this can be a real shock to our system. And in fact, after an encounter that feels less than satisfactory to you and likely the patient,

00:08:49 Speaker_00
Your brain can start to be very self-critical and say things like, you don't even help them. They have so many problems. They're so mad at you. They don't like you. I sure hope they go see somebody else, which again is a normal human thought.

00:09:00 Speaker_00
But over time, if at the end of every day, whether you have a challenging patient or not, you remind yourself, I helped people today. Sure, I didn't solve all of the problems.

00:09:13 Speaker_00
I didn't solve all of the back-of-the-envelope issues that they brought with me, but I showed up and listened to them, and I did the best I could for them every day.

00:09:21 Speaker_00
That, my friends, helps increase your own self-validation that you are doing a good job as a physician, and we don't solve all the issues, and not everybody's happy with us. But it is a journey as a physician, right, with these patients.

00:09:37 Speaker_00
So again, whether you're in outpatient primary care or whether you're in an emergency department or a hospitalist, I want you to take the time to remind yourself, I'm doing a good job. I'm doing the best I can. Yes, there were challenges today.

00:09:53 Speaker_00
Yes, I didn't solve all of the problems. And I'm just a human after all. I'm a physician who has certain tools, but I am not God. Right?

00:10:02 Speaker_00
I think a lot of times, because I mean, I'm not saying that all of you folks think that you're God out there, but I think that that contributes to these challenging patients is that we think we should be able to fix everybody and make everybody happy.

00:10:13 Speaker_00
And my friends, we need to let that go. No matter what we do for people, sometimes they're not going to be satisfied. But when we can feel confident that we did the best we could, we offered one suggestion, we sometimes just listen.

00:10:26 Speaker_00
That is healing for people. That is enough. So again, that's something I would love for you to try on the regular, is at the end of every day, acknowledge, I helped people today. And over time, you're going to build, build your confidence.

00:10:40 Speaker_00
And no matter what people say or do, you're going to have that deep knowing that, yeah, you're not perfect and you still do an amazing job as a physician helping patients and their families. Okay, my friends, I hope this is helpful for you.

00:10:55 Speaker_00
I know there are patients out there that definitely make you feel a little queasy, a little sick to your stomach, but get curious. Why is that? Is it because you can't solve the problem? Is it because they keep coming back?

00:11:07 Speaker_00
Is it because you think you're not good enough because you haven't figured it out yet? Is it just because they're annoying to you? Whatever it is, like, give yourself some grace and start to look at them a little more objectively.

00:11:18 Speaker_00
That alone is going to make a huge difference. OK, so I'm seeing this person with this problem and I'm going to go and give it my best shot today. OK, my friends, that is what I have for you today. How to deal with challenging patients.

00:11:33 Speaker_00
And another thing, I just want to remind you that this weekend we are doing our virtual book club on burnout, how to complete the stress cycle, and I invite you. It is a free virtual book club.

00:11:44 Speaker_00
If you're already on my email list, you're going to be receiving information about it. If you haven't yet signed up and you'd like to join my fall and winter book club series, this is book number one. We are going to be meeting Sunday on the 27th.

00:11:56 Speaker_00
7 p.m. Central. There's a link in the show notes. Please click to sign up. We will be having more books in the coming months. We are going to be talking about Brave Boundaries. We are going to be talking about Fair Play.

00:12:06 Speaker_00
And we are going to be talking about self-compassion in the Virtual Book Club. So sign up now and get on the list for the Book Club virtual series. And I look forward to seeing you on Sunday. It's going to be super awesome and fun.

00:12:19 Speaker_00
And until next week, peace and love to all of you. Are you ready to take control of your life and put these tools into action? I'm here to help. I offer free consultations for physician moms to see if my one-on-one coaching package is right for you.

00:12:35 Speaker_00
You can sign up for a free consult at www.MamaDocLifeCoach.com.