Johanna Shapiro1, Pavandeep Rakhra2, Adrianne Wong3. 1. a Department of Family Medicine , University of California Irvine School of Medicine , Orange , CA , USA. 2. b College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, College of Osteopathic Medicine , Kansas City , MO , USA. 3. c California State University , Fullerton , CA , USA.
Abstract
BACKGROUND: Physicians have long had patients whom they have labeled "difficult", but little is known about how medical students perceive difficult encounters with patients. METHODS: In this study, we analyzed 134 third year medical students' reflective essays written over an 18-month period about difficult student-patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students' observations and reflections. RESULTS: Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed "nonmedical" problems; fearful, worried, withdrawn, or "disinterested" in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in "standard" behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions. CONCLUSIONS: These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.
BACKGROUND: Physicians have long had patients whom they have labeled "difficult", but little is known about how medical students perceive difficult encounters with patients. METHODS: In this study, we analyzed 134 third year medical students' reflective essays written over an 18-month period about difficult student-patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students' observations and reflections. RESULTS: Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed "nonmedical" problems; fearful, worried, withdrawn, or "disinterested" in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in "standard" behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions. CONCLUSIONS: These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.
Authors: Johanna Shapiro; Julie Youm; Michelle Heare; Anju Hurria; Gabriella Miotto; Bao-Nhan Nguyen; Tan Nguyen; Kevin Simonson; Artur Turakhia Journal: J Med Humanit Date: 2018-12