Sometimes you need to have patience to deal with patients. We all know that one of the hardest parts of being a healthcare provider is the very subjective nature of working with the emotional aspects of patients. Choosing a treatment to render or what diagnostic test to offer is the easy part, though we spend so much of our time in training on this aspect of medicine. Unfortunately, we spend a woefully small amount of time learning the best way to deal with patients.

How do Your Patients React to Receiving Bad News?

Here’s an example. The other day I was seeing a patient who required further surgery for a bone infection in his foot. The surgery, previously performed by another provider, did not solve the problem and the patient needed a first-ray amputation. The patient was rightfully very upset about his situation and began crying. It took some time to calm the patient and help him understand his needs, as well as the benefits of his surgery.

On the same day, I saw another patient who also needed an amputation, but unfortunately, this patient required a below the knee amputation. Despite the seriousness and worse prognosis of this procedure, the patient took this information in stride. He grimly nodded saying he understood what needed to be done, and he was ready to have the procedure.

The Spectrum of Emotional Resilience

The first thing we need to do is recognize that everyone has a different level of emotional resilience, including ourselves. What we are really talking about here is the ability to adjust and react to adverse situations in a healthy manner. What we are not talking about is how optimistic a person is. A highly resilient person can still feel anger, frustration, and fear, but they react in a positive manner. It is fair to say that both of the situations described above are adverse, but the second patient reacted, on the surface at least, in a healthier manner.

If you consider each of these reactions, you’ll see that they encompass all possible reactions. Obviously, the third reaction is potentially the healthiest. I have seen all of these reactions from patients, but for me personally, the second reaction is the most frustrating. In this situation, it becomes very difficult for the patient to make a positive decision. In my experience, I have found these patients often require extra time to come to grips with their situation, and revisiting my recommendations at a later date is more effective than becoming frustrated and angry.

Bring a Family Member in or Give the Patient More Time

Obviously, during emergency situations, a decision must be made quickly. When working with patients unable to react, I have found much greater success enlisting the patient’s family to help move a decision along. The family, especially a well-respected member who is calm, is often the best way to move toward effective action.

On the other side of this equation, is the risk of complete failure if another caregiver steps in with a contrary plan. Some time ago, I was working with a patient in the hospital who had forefoot gangrene and had undergone three attempted but failed revascularizations. Sadly, it was time for the patient to undergo a below knee amputation. The patient reacted in a textbook manner consistent with reaction number two above. His son, on the other hand, was much more logical and understood the situation. He had talked his father into the procedure when another doctor (a family acquaintance) stepped in and recommended against the amputation. The patient, already fearful and virtually paralyzed by his situation, listened to the other doctor. Eventually, this doctor assumed care, failed treatment, and the patient eventually underwent the leg amputation. If the other doctor was not involved, the patient would have had physical and emotional closure much sooner.

A More Humanistic Approach

For those of us healthcare providers dealing with patients in difficult situations, I suggest the following humanistic approach:

How is Our Emotional Resilience as Caregivers?

Each of us has a different level of emotional resilience, and it is helpful to understand ourselves. If we understand our own levels of psychological flexibility, we will be more sympathetic to our patients, and thus more effective caregivers. As a final note, we all need to realize that we can all improve our own emotional resilience. To that end, here are 10 recommended methods by the American Psychological Association for improving emotional resilience²:

Remember to consider psychological resilience when working with your patients and be conscious of your own level of resilience and how that might affect how you deal with those difficult patient situations.