Bedside rounds and the so-called “difficult” patients

I read an essay on how to use bedside rounds to teach medical students about “difficult” patients. This was by a psychiatrist (What would Osler do? Learning from “difficult” patients. Kahn MW. N Engl J Med 361: 442-443, 2009).

Doctor Kahn points out how he structured the interviews with patients for this exercise. This had two parts. The first is to let the patient vent his or her feelings, frustrations and anger. Having used this technique myself, I agree how often the patient calms down after someone is willing to listen to them, however unreasonable they may be.

The second portion is to ask questions such as “Where do you live? Who is there to help you at home? What are some things you enjoy in life?”. It is not adequate if we ask. We have to listen – truly “listen deeply with compassion" and without judgment as Rev.Thich Nath Hanh and Dr.Carl Rogers would recommend. How else can we find out what the real problems are for the patient and how the patient perceives these problems. The quote from Osler by Dr.Kahn is perfectly appropriate: “ It is much more important to know what sort of a patient has a disease than what sort of disease a patient has”.