Maintaining Compassion in the Care of All

Professionalism – 6.1: Consistently demonstrate compassion, respect, honesty, integrity, accountability, altruism, prudence, social justice, and commitment to excellence in all professional and personal responsibilities.

For so called “model” patients such as those who give clear histories and always do what they are told, it is easy to act professionally and treat them with compassion. However, professionalism requires that one maintains this level of care and compassion even for patients who may be labeled as “difficult” for one reason or another. Throughout medical school, I have encountered many patients who have received this label for various reasons, and it is through these encounters I have seen the importance of maintaining professionalism in patient care.

One such patient was seen during a clinic follow up after an emergency room visit. Before I went to see her, I was warned by the resident that the patient would be “difficult”. When I got into the room, I met a very upset woman who was having trouble giving a clear history because of it how unhappy she was. She was repeating herself, struggling to speak about her symptoms, and crying as she thought about how poorly she had been feeling. She discussed how she had never felt this way before, how much she looked forward to going to sleep at night so her pain would stop, how she had no energy, and how she had lost her sense of humor. Throughout this she kept apologizing, saying she knew she was being annoying and a burden to everyone. It became clear that when she was in the emergency department she was treated very dismissively and made to feel like she was wasting everyone’s time. She kept insisting that her symptoms were real and that she was not making them up for attention. As I listened to her, I reassured her that I believed her, echoing how difficult it must be to feel so unwell. I told her that we would help her and that her concerns were being heard.

As I was able to gather more details, I started to realize that this patient was suffering from severe anxiety with panic attacks. While she had some GI symptoms that would require further evaluation, the bulk of what was bothering her seemed to be due to anxiety and panic attacks which were further worsened after being dismissed by medical professionals. As the interview progressed, the patient reported that she was actually starting to feel better, that she felt more energetic, her pain was decreasing, and she was feeling the best she had felt in a long time. She made a joke with her husband and was delighted to find her sense of humor had returned. I realized that this patient had come to the office extremely anxious that her concerns would again not be heard and that she would be brushed off as a nuisance. By being patient and an empathetic listener, I made her feel heard, decreasing her anxiety and panic so I could understand her history and symptoms in order to treat them. When I returned with the resident and attending with a plan to help her, she thanked me profusely and said she finally felt like someone was actually listening to her and trying to help. By being an empathetic and compassionate listener, this patient finally felt heard.

Another patient with whom I interacted and  was labeled “difficult” was a 14-year-old boy admitted to the hospital due to protein calorie malnutrition so severe that that his heart rate was in the 20s. This patient was a teenager, and because of this none of the residents were eager to take on his care – especially as he was a teenager with mental health issues. While my initial interest in pediatrics also stemmed from my love for younger kids, as I got to know this patient I realized how much I also enjoyed the care of adolescents. As a third-year medical student, I was able to spend more time with my patients than the residents, and it was through this patient that I first started learning what it meant to take ownership and accountability for a patient. Due to the amount of time I was able to spend with him, I was the member of the team who knew the patient best and was therefore able to contribute important input to his care. My evaluations reflected my dedication to help this patient, select comments of which are shown below.

Third year evaluation comments

One of the residents I worked with during this rotation remembered the care I gave to this patient and others like him and he brought it up on another rotation I had with him over a year later. The evaluation I received from this resident shown below hints at this.

Fourth year evaluation comment

I believe that maintaining care and compassion towards all patients is key to professionalism and will therefore work hard to continue to do so in the future. Throughout residency, I will meet many patients and families who may challenge my patience.  It may make it difficult to retain this level of compassion while also be dealing with additional responsibilities, work hours, and other stressors. However, I will remember the lessons I have learned in medical school about the importance of a consistently caring attitude to ensure my patients get the care they need and deserve.