The feelings physicians have about patients are useful clues that we have about how we are thinking and invariably, find their way into the results we obtain. Psychiatrist James Groves, MD, writes about this issue in his landmark article, “Taking Care of the Hateful Patient.” He writes, “Emotional reactions to patients cannot simply be wished away, nor is it good medicine to pretend that they do not exist…When the patient creates feelings in the doctor that are disowned or denied, errors in diagnosis and treatment are more likely to occur.”1

If we could somehow manage the negative thoughts that come up, not only will we feel better in our day-to-day practice, but we will also get better results with individual patients. Can we find some middle ground with demanding patients or family members so that we can build a mutually agreeable plan? Could you be wrong about the specific approach you set out to address the patient’s problem? What else is true about this human being lying before me with a high blood alcohol level? Is he a veteran? Is he someone’s son? Can I remember that getting checked out in the emergency department is the best place for him and not the bottom of some ditch?

If I can think of that person as someone’s son, I can generate much more compassion for the fellow. I have two sons and if one of them showed up in the emergency department, I would want him treated with empathy and given the benefit of the doubt. When I empathize with the mother of my patient, I look more closely for occult injuries, clean him up, and make sure he has a ride home. When I do the medical evaluation to rule out subdural hematoma, I accept that as part of my job as an emergency physician. I accept reality and I appreciate that my staff and I did everything that we are supposed to do for a human in that condition.

When we become aware of our frustration or anger, we can pause before overreacting or mirroring hostility. Our patients have the autonomy to question or to reject any of our suggestions or treatment plans. We can remember that our patients have their own fears, beliefs, limitations, and obligations that affect their ability to comply with the plan. Their thoughts, feelings, and actions have nothing to do with your ability or judgment as a physician.