Thursday, July 3, 2008

Just One Thing

My residency program participated in a program called Balint group. It's commonly used in family practice residencies, based on the efforts of Dr. Balint, who recognized that difficult patients bring up difficult emotional issues in medicine, and it helps to process them with other doctors. I found it to be useful as a resident, often because it was a much needed break from constant clinical information. And compared to the other hundreds of noon conferences, I think I remember more of my Balint sessions than anything else.

I had a patient in residency that I discussed in our Balint group one day. Kevin was 44 years old, and was working the system like a pro. He was morbidly obese at 450 pounds, on disability for a moderate orthopedic injury that he had suffered in his thirties, and utterly lacking in executive function. He whined, begged, cajoled, and pestered me and other providers until he got what he wanted.

My discussion was regarding my depth and breadth of negative feelings toward him. I didn't like his voice, his appearance, his smell, his lifestyle, his choices, his demands. I disliked every interaction that I had with him. I had intended to discuss some more sophisticated emotional response, but the more I talked the more it was obvious that the man disgusted me.

Our Balint leader stopped the conversation. "You are this man's doctor," he said, "and you need to find one thing, just one thing, that you can like about him, or you'll never get past this."

He was right.

I've thought of that advice often over the years, and it's been very helpful to me. So many of my patients are delightful and wonderful people, but alas, some are not.

Still, all of them are people, and if I look long and hard enough, I can find one thing that I can hold on to and feel positively about.

I am ashamed of how I felt about Kevin, as I look back on things. In my defense, he was my first real and long-term exposure to his lifestyle, and I've come to realize that it's neither unique nor particularly satisfying. I also see now that part of my disgust was due to my inexperience in dealing with difficult patients; I let him direct my care, and allowed behaviors that I would never allow at this stage in my career.

He taught me a valuable lesson, and I wish only the best for him.


TBTAM said...

Great piece of advice.

I just love your blog, BTW. Every single post is a gem.

SOCKS said...


And TBTAM, I just finished making your green bean salad w/mustard vinaigrette AGAIN. Great recipe - thank you.

rlbates said...

Ditto the above!

rxgal said...

For me, I've found it helps me when dealing with these types of patients to remind myself that every one of them is someone's father, son, brother, etc. Someone out there loves them dearly and sees a value in them that I perhaps, don't.

Anonymous said...

Unless, of course, their family can't stand them either.....

Femail doc said...

Dr. S, you and I once had a comment exchange over finding the Buddha within. Can't remember what set it off (do remember our Buddhas went off drinking together), but this finding the Buddha thing is what I do with patients I can't stand. Whatever their trappings they've acquired through their travels, I seek that little bit of common humanity. It usually works. Not always.

Anonymous said...

Dr. Smak,

Thanks for bringing that Balint Group session back to life. Reading your description, I now remember it well. Unfortunately I had forgotten it completely, and could have used it quite a few times over the last few years. Thanks for brining it back; without noon conferences to make me lose it in the shuffle anymore, I'm sure I'll remember it this time.

A residency pal.

Anonymous said...

Thank you so much. This really helps me. I'm a pediatrician, so it's not the patients that make me nuts, it's the parents.