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Duty, Empathy, and Hierarchy: Healing “Difficult Patients”

Published online by Cambridge University Press:  22 May 2019

DANISH ZAIDI
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Extract

Anthony is a fourth-year medical student, currently on service during an away surgery rotation. He is rounding with a first-year intern, Dr. Lovett, and the attending, Dr. Todd. They stop outside the room of Mr. Turpin, a 54-year-old male who has recently had a toe amputation due to uncontrolled diabetes mellitus. His chart lists him as a drug-seeker managed for chronic pain. As such, his analgesics are being closely monitored. Before entering the room, Dr. Lovett mentions that the patient had been irritated the night prior, complaining of uncontrolled pain, and upset at staff for refusing increased pain medication. Dr. Todd knows this, remarking that Mr. Turpin has a history of being a “difficult patient.”

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Departments and Columns
Information
Cambridge Quarterly of Healthcare Ethics , Volume 28 , Issue 2 , April 2019 , pp. 378 - 382
Copyright
Copyright © Cambridge University Press 2019 

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Footnotes

Acknowledgements: This paper was adapted from a 2016 submission to the AMA Conley Ethics Essay Contest.

References

Notes

1. Beauchamp, T, Childress, J. Principles of Biomedical Ethics. 5th edition. New York: Oxford University Press; 2001.Google Scholar

2. Berger, Z. Understanding communication to repair difficult patient-doctor relationships from within. American Journal of Bioethics 2012;12(5):15–6.CrossRefGoogle Scholar

3. Neumann, M, Edelhäuser, F, Tauschel, D, et al. Empathy decline and its reasons: A systematic review of studies with medical students and residents. Academic Medicine 2011;86(8):996–1009.CrossRefGoogle ScholarPubMed

4. Wasan, AD, Wootton, J, Jamison, RN. Dealing with difficult patients in your pain practice. Regional Anesthesia and Pain Medicine 2005;30(2):184–92.CrossRefGoogle ScholarPubMed

5. Miksanek, T. On caring for ‘difficult’ patients. Health Affairs 2008;27(5):1422–8.CrossRefGoogle ScholarPubMed

6. Fiester, A. The “difficult” patient reconceived: An expanded moral mandate for clinical ethics. American Journal of Bioethics 2012;12(5):2–7.CrossRefGoogle ScholarPubMed

7. Gillon, R. Ethics needs principles—four can encompass the rest—and respect for autonomy should be “first among equals.” Journal of Medical Ethics 2003;29(5):307–12.CrossRefGoogle Scholar

8. Margolis, JD. Professionalism, fiduciary duty, and health-related business leadership. JAMA 2015;313(18):1819–20.CrossRefGoogle ScholarPubMed

9. Tischler, CL, Reiss, NS, Dundas, J. The assessment and management of the violent patient in critical care hospital settings. General Hospital Psychiatry 2013;35(2):181–5.CrossRefGoogle Scholar

10. Bandini, J, Mitchell, C, Epstein-Peterson, ZD, et al. Student and faculty reflections of the hidden curriculum: How does the hidden curriculum shape students’ medical training and professionalization? American Journal of Hospital Palliative Care 2015 [Epub ahead of print].Google Scholar

11. Karnieli-Miller, O, Vu, TR, Frankel, RM, et al. 2011. Which experiences in the hidden curriculum teach students about professionalism? Academic Medicine 86(3): 369–77.CrossRefGoogle ScholarPubMed

12. Kerasidou, A, Horn, R. Making space for empathy: Supporting doctors in the emotional labour of clinical care. BMC Medical Ethics 2016;17:8.CrossRefGoogle ScholarPubMed

13. Coulehan, J, Williams, PC. Conflicting professional values in medical education. Cambridge Quarterly of Healthcare Ethics 2003;12(1):7–20.CrossRefGoogle ScholarPubMed

14. Batt-Rawden, SA, Chisolm, MS, Anton, B, et al. Teaching empathy to medical students: an updated, systematic review. Academic Medicine 2013;88(8):1171–7.CrossRefGoogle Scholar

15. Hu, YY, Fix, ML, Hevelone, ND, et al. Physicians’ needs in coping with emotional stressors: The case for peer support. Archives of Surgery 2012;147(3):212–7.CrossRefGoogle ScholarPubMed

16. Guille, C, Speller, H, Laff, R. Utilization and barriers to mental health services among depressed medical interns: A prospective multisite study. Journal of Graduate Medical Education 2010;2(2):210–4.CrossRefGoogle ScholarPubMed

17. Mavis, B, Sousa, A, Lipscomb, W, et al. Learning about medical student mistreatment from responses to the medical school graduation questionnaire. Academic Medicine 2014;89(5):705–711.CrossRefGoogle ScholarPubMed

18. Brainard, AH, Brislen, HC. Viewpoint: learning professionalism: A view from the trenches. Academic Medicine 2007;82(11):1010-4.CrossRefGoogle ScholarPubMed

19. Angoff, NR, Duncan, L, Roxas, N, et al. Power day: Addressing the use and abuse of power in medical training. Journal of Bioethical Inquiry 2016;13(2):203–13.CrossRefGoogle ScholarPubMed