Present Issue 
Past Issues 

Present Issue 
Past Issues 

SMA Editorial Board 

Letters to the Editor 


This site is supported by Health ONE

President’s Forum

"CME on the Practice of Medicine"

Earlier this month, I received a telephone call from a young doctor asking me how he could deal with difficult patients. I was rather curious and asked him the context of the request.

He said that he felt rather aggrieved that after all he had done for one of his patients, he was threatened with a complaint. The context of his request was a consultation where a mother had brought along her 5-year-old child to see him. The reason for the encounter was a recurrent pain in the child’s knee. There were no abnormal findings on the physical examination. The doctor noted that the mother was very anxious. To reduce the anxiety of the mother, this doctor offered to order an X-ray of the knee. As a result, the mother had to wait for the X-ray to be taken. When the X-ray was done, this young doctor gave an interim "wet-film" report and added that the radiologist will give a definitive report on it later. She was given a date in the following week to return to review the radiologist’s report.

She scolded the doctor for making her return. More exchanges followed and another doctor had to intervene. The young doctor said that throughout the conversation, she was intimidating and aggressive. "It is truly such patients that tarnish the joy of practising medicine," he added.

I told him that one should not be destroyed by the aggressive patients that he occasionally meets. Certainly, this experience will not be the last in the days of his professional life ahead.

How do doctors cope with the negative impact that such patients bring with them? One way is to have forums where doctors can share and discuss how they can deal with those patients whom they perceive to be difficult. One pioneer in this area is Dr Michael Balint who practised in the 1950s. He used to conduct sessions for doctors to ventilate about their patients and also to stimulate reflections on the whole subject of the doctor-patient relationship. His sessions certainly helped his colleagues doctors and there are now Balint groups modelled after the sessions he pioneered.

There are many other strategies that can be used to pacify difficult people. The behaviourists call them people-handling skills.

Another strategy is to have a cognitive redefinition of the whole situation to prevent oneself from being too adversely affected. The cognitive redefinition here is to focus on the reasonable majority instead of the troublesome minority. It is important to remind ourselves that the majority of our patients are grateful, responsive and considerate. They ask if you have taken your meals. They apologise for troubling you. They observe that you are working very hard. Some may even buy snacks for you and insist that you eat them before seeing the next patient. These patients collectively make doctoring a fulfilling human experience. The more veteran doctors will be able to recount many of such patients.

Back to this young colleague of mine. He observed that there should be seminars on practice issues as there are enough of CME on medical knowledge but not the practice of it. Yes, my young colleague is right. We do need CME on the practice of medicine too. Food for thought.