The best way to ensure that I’ll run late in clinic is to start late. I avoid such delayed starts as scabies, yet, sometimes it’s unavoidable. I walked into my 1:30 appointment at 1:35. “Can I ask you a question?” my bony, patient with the long gray beard asked. “Sure.” I replied. “Is your time important to you?” he snapped.
Oh, boy. Here we go.
“I’m sorry I’m running late and kept you waiting,” I offered, “but I had a sick patient this morning.” When he retorted that his time was important, too, I interrupted him.
“Please sit on the exam table and tell me how I can help you so we don’t waste any more of your time.” He went on to complain that the treatments for his facial seborrheic dermatitis did not resolve the problem. When he stops treatment, it flares. I explained that this was a chronic condition and that he could manage it with my help. He resisted, but with each parry, his aggressiveness weakened. We reviewed behavior, product, and medication options for him. By the end of the visit, he was (mostly) pleased and left with a plan and prescription to help.
Early in my career, this appointment might have been disastrous: It would have ruined my afternoon and possibly led to a formal patient complaint. His antagonistic comments and boorish behavior would have unsettled me. But it didn’t now.
I had the confidence to know his diagnosis and how to help him, despite his dissatisfaction.Those with strong self-confidence not only have better patient satisfaction and higher quality but also are more efficient and have high level of satisfaction with their career. When your confidence is low, medical decision making and managing patient expectations become difficult. This is particularly true when a patient comes “informed.” Often their knowledge is helpful but, as we know, sometimes it’s bogus, even detrimental. Although we ought to have come a long way from the brash doctor-knows-best days of our past, we also ought not capitulate to patients. Sometimes, you have to be the doctor. Balancing confidence with compassion is tricky yet essential to success.
When I meet with our young doctors, I try to provide feedback not only on their medical acumen but also on their confidence to deploy that expertise. Like a skill, self-confidence can be improved. The best way is to recognize difficult conversations and do not avoid them. When you feel your face flush and heart race, take a good belly breath and step into it. You don’t have to confront or argue with your patient, you do have to assert and negotiate. Helping a difficult patient can feel like you’ve done something wrong, but chances are, you haven’t. Reframe the situation, think of it as you doing the hard work to help them. Being confident is as important as getting the diagnosis right. Even when you don’t know the diagnosis, you can be most helpful when you are direct and say so. “I’m not sure what you have, but here is how I’m going to help you.”
To improve self-confidence you’ll have to practice. When you have a difficult visit that ultimately ended well, make a note of it. Reflect on it. The next time you have a challenging patient, remember your previous success and how you felt. Then breathe and do it again. After all, you are the doctor.
Dr. Benabio is director of health care transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at [email protected].