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What Makes "Difficult Patients" Difficult for Medical Students?
Jody E Steinauer1, Patricia O'Sullivan, Felisa Preskill
1J.E. Steinauer is professor, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, California. P. O'Sullivan is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. F. Preskill is associate director for innovating education in reproductive health, University of California, San Francisco, School of Medicine, San Francisco, California. O. ten Cate is professor of medical education, University Medical Center Utrecht, Utrecht, the Netherlands. A. Teherani is professor, Division of General Internal Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.
Medical students experience negative emotions toward "difficult patients" due to interference with learning goals and patient care expectations. Understanding these challenges can improve clinical teaching and patient communication strategies.
Area of Science:
- Medical Education
- Patient-Physician Communication
- Psychology
Background:
- Physicians often struggle to provide optimal care for patients perceived as
- difficult.
Purpose of the Study:
- To explore medical students' experiences with
- difficult patients
- to inform clinical teaching on effective communication and patient-centered care.
Main Methods:
- Qualitative interviews with 26 fourth-year medical students.
- Constructivist grounded theory analysis of transcribed interviews.
Main Results:
- Students reported negative emotions toward patients and their behaviors.
- These feelings were intensified by patient interference with students' desire to perform well, expectations of patient-centered care, and lack of authority to improve patient outcomes.
Conclusions:
- Findings can be explained by professional identity formation and goal orientation theories.
- Educators should use these insights to train medical students in managing interactions with challenging patients and delivering high-quality care.