Of all the problems we face in clinical medicine, few are more vexing than patient interactions that don’t go well. Dealing with a “difficult patient,” as they’re commonly referred to, can ruin your day and set off a spiraling cascade of thoughts and emotions. Those patient encounters frustrate us and drain us as clinicians. They can leave us feeling at once helpless and self-righteous, empathetic and disdainful. Often, they make us want to run away. Other times, they suck us in, to an uncomfortable degree. I’d say doctors spend as much – if not more – time talking to each other about difficult patients as they do about difficult diagnoses.
Hearing Dr. Autumn Fiester lecture on the difficult patient was one of those rare moments when a phenomenon I thought I had a handle on based on my own experience was completely reframed. Her ideas led me to see the problem from an entirely different angle, and to reinterpret my past experiences as a result.
Autumn Fiester is a philosopher and bioethicist at the University of Pennsylvania, where she is Vice Chair for Education in the Department of Medical Ethics & Health Policy at the Perelman School of Medicine as well as the Faculty Program Director for the Master of Bioethics (MBE) and Master of Science in Medical Ethics (MSME) degrees. She is the Director of the Penn Program in Clinical Conflict Management, which promotes conflict resolution training for clinical providers and clinical ethics consultants. She is the author of over 100 publications in the areas of clinical ethics, clinical conflict management, and more.
I think my conversation with Autumn will really appeal to clinicians who have necessarily had the experience of navigating conflictual or dysfunctional patient relationships. But I also think what Autumn has to say is enlightening for anyone who’s been a patient. As she says, we have all been, or have the potential to be, difficult patients.
This is the 20th episode of “Practicing,” a milestone I’m not sure I ever thought I’d reach when I started the podcast two years ago. It seems like a good time for me to take a break, regroup and dedicate some time to other projects. Now, this isn’t a farewell, it’s just a “see you later.” I may return with the occasional interview over the coming months, but my hope is to come back with fresh ideas. So stay subscribed! Thanks to all of you for your precious attention, and to those of you who sent feedback, subscribed, shared or rated the show, or helped and supported me in countless other ways. I couldn’t have done it without you. And of course thanks to all my guests – you are what Practicing is all about.