MedEdPORTAL (Feb 2014)
Caring for Challenging Patients Workshop
Abstract
Abstract Introduction Patient noncompliance, irrationality, differing cultural beliefs, and countless other difficult situations test a physician's ability to control his/her own emotions and provide patient-centered care. While doctors are still taught to practice medicine objectively and to disregard personal feelings, it is unwise to assume that this is always possible or even preferable. Our workshop is unique in that we ask learners to describe their own experiences and feelings of frustration with patients as the trigger to provoke reflection and then actively participate in discussion. Thereafter, we use a combination of leaner-provided cases and theoretical cases to explore strategies for developing self-awareness and empathy. Methods This workshop consists of two components. In the first section, students are asked to describe specific patient interactions in which they felt their buttons pushed by patients. They are to focus on patient scenarios in which the patients' behaviors made them feel anger, frustration, or annoyance, feelings that students are not often encouraged to discuss. After a discussion, the group reviews strategies for managing those reactions so they do not interfere with the patient-physician relationship. In the second section, specific cases that often cause students and physicians to react with strong feelings are reviewed. Results Since 2008, the workshop has been integrated into the University of California, San Francisco, School of Medicine third-year OB-GYN core clerkship. During that time, students have consistently given it positive reviews in routine course evaluations. In addition, early in the development of the workshop, a qualitative evaluation was done through interviews of 16 students. These students reported that the workshop met the intended objectives. They especially valued the opportunities for reflection and for strategizing about ways to find empathy for patients. Discussion The main challenge in facilitating this workshop is to create an environment where learners feel comfortable discussing their own judgmental feelings and where the facilitator can challenge the participants to explore those feelings without breaking trust. Facilitators can help create this environment by setting ground rules at the start of the workshop and disclosing their own points of discomfort to normalize the presence of judgment in some patient encounters. Additionally, it is important to consider modifying the objectives, cases, and materials to fit the specific needs of the target group for each workshop.
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