Through the eyes of a “difficult” patient

Moss-BannerDuring shift change you get a hand-off on one of your patients, “a 68 year old Chinese man who was admitted again for fluid over load because he continues to be noncompliant with his medications and diet. His provider prescribed the meds to manage his heart failure related to his chronic unmanaged asthma. Adult protective services recently removed him from his home where he was living with his son, because it was pretty apparent his son was neglecting him. I mean you should read the case file, the guy’s bathroom was covered in feces from a broken toilet, his floor was caked in black mold. Watch out for the son, he keeps causing a scene every time you try to talk to the patient. And the patient wants to move back in with his son, but that is obviously not going to happen because this guy cannot take care of himself and it’s pretty clear his son is not going to take care of him. Get ready this family is difficult. I would stay outta there as much as you can.”*

I have had a hand-off like this, and I am sure you have too. One that makes you automatically develop an image of who you are about to care for, and often put them into a category of “this is what they are going to be like” before you even meet them. Often times the person who is sharing this with you is usually trying to help prepare you, while also decompressing from what was most likely an extremely long 12 hours. The problem here is when we are presented with a patient that is labeled difficult it allows us to detach from them before we even introduce ourselves. And when we detach from the beginning, we miss the opportunity to learn about their truths of how they got here, what they really need from us to leave better than when they arrived and most importantly eliminating our ability to provide truly compassionate care.

I wrote this guided imagery (with editing help from my dear friend Janell Senn) for a group project in response to an experience one of my classmates had with a client like the one in the above hand-off report as part of our presentation. I wanted the rest of my peers to reconnect to the part of them that makes it difficult to shut down and shut off, and for any of you that listen to this – I want that for you too. The next time you meet a person that makes you feel frustrated for the way they live or have a patient you want to call “difficult” or “non-compliant,” you might step back and examine your own compassion switch and be honest if you need to turn it back on.

(To play audio click your mouse on the empty space to the left side of the audio toolbar next to 00:00)

*hypothetical patient

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