The "Difficult Patient" vs. the "Difficult Doctor"

Topic: Connecting minds

The following story is an example of how our sessions with a patient may go offtrack without our realizing what is happening until it is too late, quick to blame the patient as the „difficult one“. This is not a real-life story, but one based on my experience working in a supervising capacity with doctors, in our own field and in oncology. This is a composite picture from many sources, originally written as a script for an educational video. Privacy is protected as this is not based on any particular persons or events.



The main point being made is that, yes, patients can be difficult, boring, negativistic and blaming. The tendency is to blame the patient. We, as professionals, have to work with and work through difficult moments with our patients. This requires being observant, empathic and skilful. At the same time, we have to be aware of our own issues; be they imported from our private lives, from work or our countertranference, acted out in a session.


John, gaunt and grayish-looking, is invited into the doctor ´s office after 20 minutes delay.


Gudrun, the oncologist, gazing at the computer screen, invites him to sit down. „Sorry to keep you waiting“.


John, slumped in the chair: „Guess it´s all right. I am used to be kept waiting“.


Gudrun, doing her best to sound cheerful: „And how are we doing today“?


John: „I don´t know how WE are doing, but I am not good. Terrible in fact. The new painkiller is not doing anything for me. You are not doing anything for me“.


Not a good start for what is expected to be a supportive conversation. Let me give you some background. John, 58 years old, with metastatic colon cancer, a career as a chronically frustrated teacher, his wife an administrator at the Ministry of Welfare. Gudrun trained as an oncologist at the Karolinska, moved back to Iceland due to family issues, with two children and husband, leaving an unfinished doctoral thesis behind. Now working in an understaffed oncology clinic at the University Hospital in Reykjavik.


Gudrun, turning in her chair and, looking for the first time straight at John. „How can you say this? Your new medications are working, (gazing again at the computer screen) your blood tests came out just fine. To Florida with your wife. Wonderful vacation. I don´t understand“.


John, with something resembling a smile on his face: „OK. So is my suffering now part of the treatment“


Gudrun, leaning back in her chair, takes a deep breath: „I am doing my best to help you. I am not known for giving up. In fact, I am working my ass off in this hospital. And the team has been amazing“.


John: „Oh yes. The team. Just forgot... the TEAM“.


Obviously, a clash. So, A little more background information. John got up late. His wife was stressed, had to drop him off at the hospital before an important work meeting. Their relationship has often been strained, mostly due to John´s passive-agressive behaviour, inducing guilt in others. Gudrun, her perfectionistic demands of herself (remember the doctorate thesis), lead to interpersonal clashes.


Her daydreaming, ADD-diagnosed artist husband is of no help. She had been late for the appointment with John, got cought up in overexplaining something to the junior staff.


So, who is the difficult one?


Obviously, the patient is negativistic, passive-aggressive, feels he is playing second fiddle in his wife´s life; feels devalued by his inattentive physician, both before and in their meeting. He is in severe somatic pain, but mostly fearful of his prognosis. The doctor, struggling with subconscious fears of being inadequate, is in no mood to be confronted with the minor lapse of being late, and the difficulties in alleviating the patient´s fear and pain.


Culprit: Neither one.


Solution: Not only do we need to use empathy and understanding of our patients, but we must know ourselves, our interpersonal strengths and weaknesses. This also includes recognition of our stress level, and, in today ´s work environment, to be aware of the syndrome of burnout rearing its ugly head.


Advice: Before you enter the workplace in the morning, pause, take a deep breath, think of whatever unfinished issues may be troubling you. Leave them outside. □