Professionalism is a concept that has come up several times during my third and fourth year rotations. Over the course of my rotations, I have worked with very difficult patients where my team’s ability to conduct themselves in a professional manner has been tested. One patient who I can still remember clearly was a female patient I encountered during my inpatient psychiatry rotation. This patient was diagnosed with borderline personality disorder and frequently was admitting to the hospital for suicidal ideation. While in the hospital, the patient would make many demands, and often medically unsafe requests and would become extremely agitated when her requests were denied. During my rotation, I had the great opportunity to watch two different physicians work with this patient. From this experience, I realized one physician was able build significantly stronger rapport with the patient, and this was due to the fact that she was able to maintain completely calm with the patient, ensure the patient’s concerns were fully voiced, and find a medically safe compromise. Additionally, she was always completely honest with the patient and did not hold back information, even if it was difficult for the patient to hear. In other words, this physician was able to remain completely professional throughout an extremely difficult patient encounter and was rewarded with the patient’s trust.
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After my psychiatry rotation, I feel like I learned several different techniques in how to stay consistently professional throughout patient encounters. From doing this, I felt like I was able to start earning more trust and build better rapport with my patients. My efforts have been quantitatively measured through consistently getting 100% on my OSCEs for professionalism. More importantly, my constant drive to conduct myself professionally can be seen through my patient encounters.
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One particularly difficult patient I had was a patient who had received a bone marrow transplant 3 years earlier for AML. Her leukemia was treated, but unfortunately she has been suffering from chronic graft versus host disease (GVHD), which has drastically affected her pulmonary function. Before she was admitted to the hospital, she had finally been off supplementary oxygen for a few weeks, but was admitted with fevers, cough and increasing respiratory insufficiency. She was diagnosed with the flu and was in a worse off respiratory condition than she had been for the last year. She never recovered back to her baseline function and was admitted two more times during my rotation.
This patient was visibly frustrated every time I walked in her room and told her all we could do was wait to see if she would get any better. She would get very agitated when she had been doing better for a day but then relapsed the next day. When the team and I discussed long-term prognosis for her, we had given her false hope by mentioning the possibility of a lung transplant or a new clinical trial, later finding out she was not eligible for either. I felt so uncomfortable walking into her room because I felt as if we were constantly disappointing her and making her more and more frustrated; however, I continued to visit her each day and tell her the plan. I continued to be honest with her and would admit each day that we didn’t really have a great plan yet. I expected her to eventually throw me out of her room or stop talking to me each morning, but she became friendlier and kinder each day. She would eventually open up more about her life when I visited. She stated that regardless with all her complications with GVHD, she was so grateful to have an amazing team of doctors working with her. She even shared her plans about donating her body to science to give back. I was so touched by everything she told me, and how comfortable she was talking to me.
These two experiences, along with several other difficult patient encounters really taught me the importance of maintaining professionalism and the results from doing so. I know that not all difficult patients will eventually change their minds or attitudes, but I do believe that the best way to approach these patients is to continuously stay compassionate towards them, truly listen to their concerns, and be as honest as possible. With many difficult patients and incredibly busy services, it is easy to spend less time with the patients that make us feel uncomfortable, but I have learned how essential it is to not give up on these patients.