How Doctors Respond to 'Difficult' Patients: A Reflection by Kendra Peterson, MD

   Kendra Peterson, MD is a neurologist in Palo Alto, California, and a member of the Pegasus Physician Writers at Stanford. Her poem  'The "Difficult Patient " ' appears in the Fall 2017 issue of the Intima.

Kendra Peterson, MD is a neurologist in Palo Alto, California, and a member of the Pegasus Physician Writers at Stanford. Her poem 'The "Difficult Patient "' appears in the Fall 2017 issue of the Intima.

In Sarah Shirley’s poem ‘Wernicke-Korsakoff’ (Intima, Spring, 2017), she elucidates the dilemma of caring for a patient who is angry, non-compliant, inarticulate, hostile, confused, or otherwise “difficult.” How do we reach across the barriers that such patients present, to find an opening through which we can glean from them the information we need to take care of them, and to establish mutual trust? Her poem is a reminder for all of us that each encounter we have is with a person. A person with a complicated story, a person with a history of experiences and fears and preferences and strengths and struggles and defenses. Finding an entrance into that story can be the first essential step to helping and caring.

My own poem ‘The “Difficult Patient” ’ (Intima Fall 2017) also describes an interaction with a patient who might be termed “difficult.” While I dislike this label being applied to  patients, (and thus put it in quotation marks), it is a term  I have heard commonly throughout my career. Discussion of this poem among the members of my physicians’ writing workshop led us to probe what makes our encounters with some patients “difficult.” Is it characteristics that are inherent in the patient? Or is the difficulty an uncomfortable response that is triggered in us, a challenge, frustration, inadequacy, defensiveness, or inconvenience? Regardless, to label a patient “difficult” can be to dismiss him, to see him as someone whose full story is not important or is not to be trusted.

I applaud Sarah Shirley for her carefully crafted and beautiful poem. And I admire that as a medical student, she already recognizes and articulates our obligation and commitment to care for such patients with as much diligence, curiosity, compassion, patience, and kindness as we do for those we deem “easier.”


Kendra Peterson, MD is a neurologist in Palo Alto, California, and a member of the Pegasus Physician Writers at Stanford.

© 2017 Intima: A Journal of Narrative Medicine