We wrote such beautiful essays and personal statements on our medical school and  residency applications. But, over time, our mission to heal and justly distribute the  bounty of our medical skills somehow devolved into mocking patients in the breakroom and roasting them mercilessly in online closed social media forums. We resent many of the patients for coming to the emergency department and we blame them for their illness or injuries. Then we justify those thoughts and beliefs by saying that everybody thinks and vents to each other in this way.

We define patients as “difficult” when they do not hew to the imagined rule book we have created for “good” patients. I have written that, “… good patients are actually people who reflect what the physician views in herself as desirable characteristics. Treatment of these patients leads to congenial, effective, mutually rewarding interactions.”¹

The patients and their families who don’t follow the rules get labeled as “difficult.” Interacting with them makes the physician feel uncomfortable, inadequate, or frustrated. Those sour interactions follow us home, drive us to the breakroom for a glazed doughnut or send us home at the end of our day to a few glasses of wine. We scan our email for alternate job offerings and dream about our escape route from clinical medicine. What can be done about these burdensome interactions with difficult patients?

The first thing to realize—and this might be the hardest—is that the problem lies with you. Passing judgement on what makes a good patient and believing non-compliers are “difficult” are some of the most toxic and unhelpful thoughts you can have. And those thoughts are entirely optional. You can set them aside and find more useful and accepting thoughts about even your most challenging patients.

How Can Any of Us Change Our Very Negative Thoughts and Beliefs?

Primarily, we must realize that we have a negativity bias. This is a very human tendency that probably developed when our cavemen ancestors had to scan the horizon for constant threats. Our brains go naturally to find what might be dangerous or going wrong. In medical school and residency, we are subconsciously taught to mock and degrade our patients by judgingly speaking about drunks and druggies and labeling our patients as diabetics and sicklers. We frame our physician group-think as “the truth.” Everybody talks this way so we don’t even consciously hear how terrible it sounds. It becomes habit.