It’s a normal Tuesday night at work. I’m walking to the ED, creating a sketch of my next patient and the skeleton of a treatment plan: middle-aged male in a motor vehicle collision, concern for facial fractures. When I get to the ED, however, things take a turn. The nurse caring for the patient stops me before I can enter his room: “You’re taking care of bed C? Good luck.” I nod, steeling myself for the encounter — though unsure of exactly what I’m preparing for.
When I step inside, I notice immediately that my patient is handcuffed to his bed. He’s also not alone — there’s a police escort sitting somberly in the corner. Taking a deep breath, I cautiously begin to engage the patient. He’s visibly intoxicated and answers my questions in a brusque manner as I perform my physical exam, police officer gazing on.
As I head out of the room, another officer stops me. “The patient is in custody, he shot at an officer during a chase,” they say. I nod, unsure how to respond. The comment is surely meant as a warning that the patient is physically dangerous. Leaving the ED, I can feel that I’m leaving my guard up emotionally as well.
Over the next several days, as the patient sobers up, his personality slowly comes out. I attempt to shake our initial encounter and disregard what I’ve been told by others in the ED, though it’s clear he’s a sour man, intent on being rude to everyone he encounters. I approach each visit attempting to win him over, showing everyone, including myself, that despite what he has done, he’s not a bad person. That he’s still worthy of the same care as the little old lady who slipped while gardening, as the kid who got hurt during his hockey game.
However, the patient seems to respond conversely to my effort. He returns each attempt at empathy with scorn. Despite this, I try to find points of commonality. Gesturing at the basketball game on TV, I say, “It’s been a pretty wild series so far.” The patient’s eyes flicker toward me for a second, then they are fixated back on the playoffs. I quickly switch gears to the medical, asking about his pain and diet, and setting the agenda for the day. Each remark is met with steely silence.
As the days go on, I cave in. I speak to him when necessary, keeping my exams short. When it’s time for discharge, I breathe a sigh of relief — and quickly feel shame for giving in to my dislike of the patient.
Medicine, at its core, is an interpersonal art. This relationality is often one of the richest sources of joy — from parents still in awe as they cradle a newborn baby to the centenarian stopping by clinic to drop off Christmas cards 15 years out from their cancer treatment. And yet, the relational aspect of medicine can also foster negative emotions. For every patient who will call to thank you for saving their life, there is another who will call to curse you in the most personal ways, or another, like my patient above, who will blatantly shut you out.
As time has gone by, I have replayed my encounter with my trauma patient over and over again in my mind, thinking of what I would do differently. With each review I’ve scrutinized our introduction, wondering if I said or did something that set us off on the wrong foot. And yet, each time, I’ve come to the same conclusion: sometimes no matter what we do, our patients won’t like us. They may even actively dislike us. And we may feel the same. But that dynamic is part of what makes medicine the art that it is. I can still revel in medicine’s relational aspect — even while cognizant of the reality that not all encounters will be happy or rewarding.
Since my experience with that trauma patient, I’ve cared for many other patients who have elicited negative feelings. Some have harmed people, intentionally and unintentionally. Some have simply been rude, dismissive of attempts to help them. It’s in these moments when I find myself getting frustrated and angry that I pause, acknowledge that feeling something is what makes us human, and commit anew to caring for the patient in front of me, as best as I can.
Now, this approach flies in the face of the expectation in medicine that clinicians remain neutral. And yet, denying that we are affected by the way our patients treat us won’t do us any good — we’ll be moving on autopilot, unable to give patients the care they deserve. To my fellow clinicians, I urge you to pause and take stock of your feelings. Because remember: if we want to feel the joy in medicine, we must allow ourselves to feel the frustration as well.
Have you ever had a patient whom you didn’t like, and vice-versa? Share how you dealt with the situation in the comments.
Marc Drake is a fifth-year resident in the Department of Otolaryngology and Communication Sciences at the Medical College of Wisconsin. His clinical interests include facial reconstruction, violence prevention, and the interplay between urban design and health care. Dr. Drake is a 2024–2025 Doximity Op-Med Fellow.
Illustration by April Brust
