In the long list of tasks that the medical staff faces every day, interactions with challenging patients and their families remains a persistent problem. Medical officers and administrators can authorize the training modules and publish the lofty mission statements, but their efforts often fall short. Although it sounds hopelessly optimistic, perhaps they need to promote a policy of love.
The first instincts of the paramedics, nurses, and doctors don’t go first to love — they go to protection and self-preservation. Healthcare professionals must consider their reputations, their ethics, and their livelihoods; loving their patients sounds too artificial, too hokey.
As I researched in preparation to write my book, a seminal article by James E. Groves, MD, “Taking Care of the Hateful Patient,”(1) helped me understand the challenges that physicians have in dealing with some of their patients.
Groves, a psychiatrist at Massachusetts General Hospital, wrote about several stereotypical patient types that physicians dread and explained the patients’ and the doctors’ issues from the perspective of a psychiatrist. Before this article was published in 1978, physicians were unlikely to admit that they disliked some of their patients.
Most of the interactions among doctors, nurses, their patients, and the patients’ families appear to be pleasant and mutually beneficial. In real life, however, studies show that 15–20% of interactions between physicians and their patients are counterproductive, stressful, and difficult. The difficult interactions drag down morale and push physicians and nurses toward early retirement; the resulting staffing shortages compromise care and cost the hospital millions of dollars.
In my research, I also read a short essay by Suzanne Koven, MD, a primary care internist in Boston. In “‘The Hateful Patient’ Revisited,” Koven tells the story of the long-term relationship with one of her patients who complained about everything.(2) At every visit, this patient railed about the location of the office, the medications the doctor prescribed, the length of her visits, and how the doctor was not really helping her. This complaining and griping had gone on for years when, one day, there came a shift.
From “The Hateful Patient’ Revisited”:
“One day, something — I don’t know what — made me interrupt my patient’s accusatory litany to ask, ‘Is there anything I can do to make you happy?’
Maybe it was because she had mellowed a little over time. Now that she was old and very sick, her negativity had lost some of its nasty edge. Maybe it was because we both knew she wouldn’t live much longer. Maybe it was because my mother, who was about this woman’s age, who colored her hair nearly the same auburn shade, whose suffering I felt as powerless to relieve, was also dying.
Had I, too, mellowed? Had my stiff, professional forbearance of this woman softened into empathy or, a word we don’t use as much anymore, sympathy? Or could it be that what I felt for the old woman, widowed, in a wheelchair, tethered to an oxygen tank, was — now here’s a word you never hear anymore — pity?
Or, perhaps, I was merely exasperated.
Whatever it was that prompted my question, her surprising answer popped out as if it had been on the tip of my patient’s sharp tongue all the years I had known her. She said:
‘Just tell me that you love me.’
I didn’t know how to respond. I didn’t love her. I didn’t even like her.”
Koven was forced in that moment to explore the thoughts and feelings that she did have for the cantankerous old lady. What she discovered was that she felt “feelings of guilt, protectiveness, admiration, annoyance, helplessness, responsibility, inadequacy, defensiveness, frustration, and even affection.” Acknowledging the affection, Koven recalled, helped her bridge the gap between her patient and herself.
WHAT DOES LOVE HAVE TO DO WITH IT?
Is love one of the feelings that physicians and nurses practicing in clinics, wards, and emergency departments should have when interacting with their patients? Do they even want to love their patients? Is that too hopelessly idealistic for today’s healthcare professionals who are busy, overworked, and cynical? And what is love anyway?
Love is an emotion that occurs when one thinks in a certain way. Because I love my morning cup of coffee, as my hands enclose the ceramic mug, I appreciate that it is warm and welcoming with just the right note of bitterness; each caffeinated sip is the promise of a new day. I look forward to enjoying that caffeinated little hug each morning. My brain interprets these thoughts as love.
From Leviticus 19:18: “You shall not take vengeance or bear a grudge against the sons of your own people, but you shall love your neighbor as yourself.” This Bible verse translates as respecting others and regarding their needs and desires as highly as we regard our own. How can love become part of the way doctors and nurses regard the neighbors who become their patients?
Love translates to feelings of affection, admiration, compassion, empathy, and concern for another individual. Those feelings come from what we think; for those physicians who care for patients over years and decades, there is ample time to formulate stories, make judgments, and acquire negative opinions regarding the behaviors of their patients.
WHAT IF ALL DOCTORS AND NURSES LOVED THEIR PATIENTS?
If doctors and nurses loved their patients, they would want their patients to get well, not suffer. They would respect their patients’ lives and accept their decisions even when they don’t agree with their choices. Wouldn’t it be best if the medical professionals valued their patients’ humanity and understood their struggles?
When I, as a physician, think loving thoughts and feel loving emotions, I act in a way that expresses kindness, caring, and empathy. I am more attentive, kinder, more understanding, and I give my patients the benefit of the doubt — even the challenging ones who seem determined to make themselves sick.
For angry, aggressive, and violent patients, I look for a way to forgive their behavior. Religious folks will say they would follow Jesus’ admonition in the New Testament and turn the other cheek, responding without malice. A decade ago, people wore bracelets displaying the letters WWJD, what would Jesus do? Since my family and I are not Christians, we co-opted that one into what would Joan do?
For one thing, Joan would advise her physician and nurse colleagues to be less judgmental of their challenging patients. As an emergency physician in a busy suburban department, I found that fewer thoughts of disapproval and blame toward patients opened us up to thoughts of empathy and curiosity.
We asked better questions. We asked why patients stopped taking their medicines. We inquired about where they were living and how they could get to their follow-up appointments. We questioned whether they were hungry.
With this information, we could formulate alternative plans, meet basic needs, and find solutions with our patients.
WWJD? Joan would advise that doctors and nurses search for everything that is true about the cantankerous lady or the hostile, unhoused man. That lady is likely someone’s mother or sister. The man is a human being of value and substance, even though he desperately needs a shower. He is also someone’s son. As the mother of two sons, I care about how he is treated, and I empathize with his mother, who isn’t even there.
FEELING THE LOVE
Feeling love would help us all. Nurses would pay more attention to their patients and touch them with kindness. Doctors would be less dismissive of the folks who complain, dramatize, and bully. Love would feel better than intolerance and resentment.
Don’t just preach love for the sake of the patients, although it would help them. Do it for yourselves because it feels so good. Kindness, empathy, and affection feel wonderful. James Taylor sings in “Carolina in My Mind,” “There ain’t no doubt in no one’s mind that love’s the finest thing around.” Love because you deserve it.
References
Groves JE. Taking Care of the Hateful Patient. N Engl J Med. 1978;298(16):883–887. https://doi.org/10.1056/NEJM197804202981605
Koven S. “The Hateful Patient” Revisited. Boston.com. March 1, 2012. https://www.boston.com/news/local-news/2012/03/01/the-hateful-patient-revisited .