Dealing with Discouraged Patients
You're scanning the EMR and you see four office visits in the past month with the same chief complaint. You walk in the room knowing it's not going to be an average cut-and-dry visit. The patient is frustrated about their bowel, their bladder or their other non-emergent complaint that keeps driving them back to the office, and you have to address them with firm confidence.
I have at least one or two of these patients per day and their persistent problem usually has an underlying obvious patient-dependent factor. A sampling includes the frustrated smoker with a lingering sinusitis, the overactive bladder women who refused surgical options, or the back pain patient who keeps missing their appointment with pain management - and I could go on. It's during encounters like that I am eternally grateful I can always tell the patient that, "I'm just going to step out of the room to discuss this with my attending" and basically pass the buck to someone else.
I also can't understate the power of a referral - which by the time they've returned again has usually been offered, but for various factors, the patient hasn't yet been able to go see. The struggle for me, beside the medical aspect of determining a diagnosis and treatment plan, is that I become frustrated with the patient. My inability to fix their core medical issue, though non-emergent and non-life-threatening shakes my own confidence, "What am I missing? What else could be going on here?"
Most of the time malignancy cannot even be in the diagnosis, but it can slip in subtly. "I could be missing cancer," is always in the back of my mind. Then, there's the fighting for prior authorizations for insurance companies for new medications, and the patient call backs that make me feel even more helpless.
So it takes a moment of perspective shift when I realize that though the patients and I may be frustrated, we are trying, we have options, and we have the greatest healthcare system in the world. We have modern medicine with all its glories and shortcomings. And it's in these moments of stepping back, even while I'm practically jogging from exam room to exam room, when it all becomes a surreal, wonderful moment of gratitude. We all have life, uncomfortable though it may be, and each day is worth being thankful about.