An actual conversation:
me: We've done a bunch of tests, and several of them are inconclusive. I'm very concerned that this might be a heart attack. I'm going to order some blood tests, and we will observe you overnight, and I will ask a cardiologist to see you in the morning.
patient: Well, you're wrong. I know it's not my heart.
me: Umm... okay. Can I ask how you know this?
patient: Don't be smart with me. I know my own body. This is not my heart.
me: Ma'am, you have diabetes, you have high blood pressure and high cholesterol. These are all risk factors for having a heart attack. Some of the tests have come back worrisome for a heart attack. It may not be a heart attack, but there is a very real possibility.
patient: Well, you don't know what you're talking about. This is not a heart attack, and I'm going home. You're just a resident. You don't know anything. You're not even a real doctor.
me: Ma'am, I admit a lot of patients to the hospital, but your case is concerning enough that I've already spoken with the cardiologist. I must urge you to reconsider.
patient: Screw you. You residents don't know what you're talking about. I want to talk to a real doctor.
me: Ma'am, I am a doctor, but I have already discussed this with two attending physicians, the attending internist and attending cardiologist.
patient: You probably lied to them and told them a bunch of lies so they'd agree with you. Or you didn't even speak to them. You're probably lying to me right now.
me: I'm not going to argue with you about this. This is a hospital, not a jail. If you want to leave, then please sign this form that states you understand that there is a very real risk of death if you leave against medical advice.
patient: I'm not signing anything! You're just doing this to cover your ass!
me: Fine, don't sign it. But you should understand that I think you're having a heart attack, and you may very well die from it, and if you leave, it is against medical advice.
patient: Whatever. I'm done with you.
The line "You're not a real doctor" is a common one that I get from irate patients, and this lady got to me, believe it or not. I am usually very cool in my patient interactions. My interns have seen patients and families scream at me. But this lady, I was pissed. Afterwards, I felt pretty bad. After all, she was frightened that she may be having a heart attack, and we all react very differently to terrible news.
People think empathy is being with a terminal patient or comforting a sorrowful family, but I think that the real challenge of empathy is understanding the belligerent patient. Because anyone can feel sorry for someone with terminal cancer. Not everyone can see from the perspective of someone yelling at you and cursing your name.
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