Why Difficult Patients Can Trigger Resentment

I have a secret. I think that’s one that a lot of doctors and nurses share. Sometimes, when I’m too overwhelmed — overbooked, hungry, tired, making another call to an insurance company in the middle of a clinic day — I find myself momentarily resenting patients for my schedule. .

As soon as this happens, I feel immediate guilt. These are the worst moments of my day. Why the hell would I resent my patients? They’re the only reason I’m here. I wouldn’t be a doctor without patients to care for. I became a doctor and did superspecialty training to help patients. People.

Recently, I started to think more about this emotion of resentment. What exactly is it and where does it come from? Is what I feel really resentment? Or is it something else?

Two books I recently read helped me explore the complicated emotion of resentment and how it might play a role in burnout among doctors and nurses.

First, Brené Brown’s most recent book, Atlas of the Heart: Mapping Meaningful Connection and the Language of Human Experience, provides a roadmap for 87 of our human emotions. (That’s right – 87!)

One emotion of the 87 that she shared was a particular struggle for her was our good old friend, resentment.

In her book, Dr. Brown shares that she initially considered resentment to belong to the anger family of emotion. Reading this, I accepted. When I feel resentment, I associate it with feeling angry.

But then she writes about her discovery that resentment, in fact, belongs to the family of envy. She explains how this discovery rocked her world. I had to close the book for a while at this point.

Wait a minute, I thought. If resentment is in the envious family, why do we (doctors) often find ourselves resenting patients who take our time? What are we envious of?

I took the time to think about how that could be true. Could it be that I’m envious that they have the time I don’t? I want to have all the time in the world to answer their questions, but the reality is that I don’t have any.

Or maybe it’s because sometimes I feel like the patient expects me to offer something more than what’s available. A remedy when there may not be one.

But is it really true? Where is it my unrealistic expectation of myself?

Here’s how Brené Brown defines resentment in his book: “Resentment is the feeling of frustration, judgment, anger, ‘better than,’ and/or hidden envy related to an injustice or perceived injustice. It is an emotion we often feel when we fail to set limits or ask for what we need, or when expectations let us down because they were based on things we cannot control, such as what others think, what they feel or how they will react.

wow, I was thinking, Healthcare ticks all of these boxes.

  • Perceived unfairness of working hours? To verify.

  • Perceived injustice? Of course, we see this every day in our dealings with insurance company denials.

But these are both extrinsic. What about the intrinsic factors on which it challenges us here?

  • Are we, as physicians, incapable of setting limits?

  • Don’t we ask for what we need?

Hard yes and yes. (Do we even know, as doctors, what our own limits are?)

And the last:

My brain had to repeat the critical parts of this: Expectations let us down when they’re based on things we can’t control.

But waitmy brain responded; I’m the doctor, I thought I was supposed to be in control.

Then the revelation: Could it be that a key to feeling less resentment is to accept how much we control do not do have in a typical day?

And a corollary: to what extent is resentment a factor of exhaustion? (For more on my personal journey with burnout, see this article).

It so happened that around the same time I was reading another excellent book, Changing Our Perception of Difficult Patients: A Guide for Physicians and Healthcare Professionalsby Joan Naidorf, DO.

Dr. Naidorf is a 30-year-old emergency physician who wrote the book to “provide[e] ideas and tools to manage our negative thoughts about difficult patients” and help “beleaguered colleagues…return to their caring guiding principles and find more enjoyment in their vitally important careers”.

In reading Dr. Naidorf’s book, I therefore did so in the spirit of wanting to understand more for myself where this specific emotion of resentment towards our “difficult” patients could come from and how to best understand it for the to go past.

Naidorf writes, “Difficult patients will never stop popping up…You can’t change them or control them – the only person you can control is you.”

I wondered how much of the resentment we might involuntarily feel about being asked to see a “difficult” patient had nothing to do with the patient but everything to do with us not feeling masters of the situation.

Naidorf also writes, “Negative thoughts about difficult patients can cause otherwise capable clinicians to feel inadequate and incompetent.”

Do we perhaps resent our difficult patients because of the negative thoughts they sometimes trigger in us? If so, how does this relate to envy, as Dr. Brown claims resentment is related? Does it make us feel inadequate?

“[Difficult patients] often make us question ourselves,” writes Naidorf, “and we need to feel comfortable with the answers.”

Again, the gap between expectations and reality creates the negative emotion.

Or, as Naidorf writes, “What if you could stop judging others so harshly and accept them exactly as they are?”

Hmmm, I thought, then ceasing harsh judgment and implementing acceptance should apply to us too. The elusive concept of self-compassion.

Perhaps the resentment/envy comes from not allowing ourselves to behave in this way because it would allow too much vulnerability. Something most of us have been conditioned to avoid in order to survive medical training.

Dr. Brown also writes of an “aha” moment she had in her struggle to understand resentment. “I’m not angry because you’re resting. I’m angry because I’m so tired and want to rest. But, unlike you, I’m going to pretend I don’t need it.”

I felt too much seen in this passage. Could it be my old sworn enemy, perfectionism, which is resurfacing? Is resentment the ugly half-sister of perfectionism?

Perhaps difficult patients can breed resentment because they make us feel like we are not meeting our own unrealistic expectations. And in this case, we need to change our unrealistic expectations of ourselves.

Dr. Naidorf’s book explores much more the complex question of what makes a patient “difficult”, but I have chosen to focus here only on resentment as a link to Dr. Brown’s book. I highly recommend both books for further reading to help doctors and nurses navigate the complex emotions our jobs can trigger.

More importantly, recognizing that we have these transient negative emotions does not make us bad people or bad healthcare professionals. It only makes us human.

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About Dr. Jennifer Lycette

Jennifer L. Lycette, MD, is a rural hematologist-oncologist, mother of three, and recovering perfectionist who is coming back from physician burnout, one word at a time. His essays have been published in
The Intima, The New England Journal of Medicine,
JAMA,
JAMA Oncology,
Journal of Clinical Oncology,
The ASCO post, and more. Connect with her on Twitter
@JL_Lycet or its website.

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