How Can I Avoid Getting Jaded?

Alisa R. Gutman, MD, PhD

Disclosures

May 22, 2012

Question:
I'm in medical school, and I'm already getting frustrated and jaded. How can I avoid feeling anger toward patients?

Response from Alisa R. Gutman, MD, PhD
Psychiatry Resident, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

I treated my first difficult patient as a medical student rotating on internal medicine. He was admitted unconscious with diabetic ketoacidosis, and the doctors saved his life. When he regained consciousness, he was belligerent and, quite frankly, mean. He yelled at us when we tried to examine him or do anything to help.

I remember complaining about this patient to my brother and asking, "Why do we even need to take care of this guy if he doesn't want our help?" This comment, coming from his previously sunny sister, shocked my brother and also surprised me. Who was this jaded person? What happened to the idealistic medical student who wanted to save the world?

It may seem like a dirty secret among clinicians, but the reality is that even the most empathetic physician can resent patients. I think there are 2 causes: angry patients and tired doctors.

During internship, I recall struggling with my feelings towards an irate patient when a wise chief resident said to me, "If you're feeling this upset, imagine what she must be feeling." Think about this for a moment. If a patient has the capacity to make you that angry, her internal milieu must be an upsetting and frightening place.

So, the real question is, how do you reclaim your empathy?

It requires taking a step back and seriously considering how someone arrived at the current situation. Even the meanest, angriest patient was once a vulnerable child. I like to think that most mean people came by their personality by being treated with contempt or anger as children.

I've thought about this a lot during shifts in psychiatric emergency departments. Patients lie to us about symptoms to gain what they need: housing, food, company. It used to really get under my skin. As it turns out, I really hate being lied to. However, like a good psychiatrist, I now consider what the patient's motivation might be. I ask myself, does this person wantto be in an emergency department lying to a doctor at 3 AM? In most cases, the answer is no.

It doesn't even take a mean patient for medical staff to feel frustrated and angry. There's a reason why, on the wards or in the emergency department, a new patient is called a "hit." More patients mean more work. For a tired and often overwhelmed intern, it's natural to start blaming patients for being sick.

But that sounds ridiculous, doesn't it? Is hating patients a natural consequence of our healthcare system? Maybe. But it's incredibly important to think about where your anger is landing and reconsider your attitude. Like the rest of us, you probably went into medicine to help people. It's not your patient's fault that her pneumonia got worse at 2 AM. I'm sure she'd also rather be asleep.

I also think that this type of resentment comes as a result of exhaustion in training. Notice as you're on rounds that attendings rarely have this attitude. So there's hope that we'll get back to a better version of ourselves and want to help people again.

I often tell medical students, "We're too young to be jaded and too educated to be stupid." There is no need to enter clinical situations with a negative attitude.

At the same time, realizing that it's normal to feel frustrated in patient care should relieve you of any guilt. Whenever you find yourself feeling anger as a clinician, take a moment to think about what's going on. For the angry patient, I recommend the compassion approach. These are opportunities to pause, reset, and actively practice compassion. In cases when your frustration stems from exhaustion, recognizing the situation also should help you reset your attitude.

processing....