The stories they tell: How third year medical students portray patients, family members, physicians, and themselves in difficult encounters

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who were angry and upset; noncompliant with treatment plans; discussed “nonmedical” problems; fearful, worried, withdrawn, or “disinterested” in their health.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.

Disclosure statement

The authors report no conflicts of interest.

Notes on contributors

Johanna Shapiro, Ph.D., is a professor of Family Medicine and Director of the Program in Medical Humanities & Arts at University of California Irvine School of Medicine. She has a longstanding interest in assessing the value of reflective practice in better understanding medical students’ perspectives on their clinical experiences.

Pavandeep Rakhra, BS, earned her BS in biochemistry and molecular biology from UC Irvine. She is presently enrolled as a second year medical student at Kansas City University of Medicine and Biosciences.

Adrianne Wong, BA, received her BA from UC Irvine with a major in psychology and social behavior and a minor in public health. She plans on attending medical school and is currently enrolled in a pre-health post-baccalaureate program.