Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

How to Respond to Off-putting Comments from Patients


Sometimes comments from patients are rooted in their own unmet fears or needs. Instead of reacting to your own discomfort in the face of such comments, remaining curious and asking open-ended questions may help you understand what’s behind such unpleasant remarks.

When I graduated med school, I remember scoffing at the idea that I’d ever struggle to maintain empathy with my patients. In my mind, that was a problem for “lesser doctors,” those who preferred golfing Friday afternoons rather than caring for patients.


However, my skills were put to the test when I met Mr. J, who’d suffered a stroke the day before. On admission, I was taken aback when he requested another physician, specifically “a real doctor,” after he saw that I was a psychiatrist-in-training.


I felt my irritation blossom at his request. But then I looked into his eyes and saw the distress on his face. I sat at his bedside and listened to his fears. I learned that most of all, he craved a sense of control after feeling that everything was stripped from him in the blink of an eye. Over the course of his stay, we discussed these issues and more, unexpectedly forming a close and meaningful relationship.


I like to think that both of us learned something from the experience. I hope Mr. J learned that despite his neurologic difficulties, his existence had meaning and purpose. I learned that off-putting comments or questions are usually the mark of unmet need or fear. Moreover, I learned that patients don’t expect me to fix every medical problem, they just want to know that their clinician cares.


Here are 3 things I try to keep in mind:


1. Approach off-putting comments with curiosity. Asking questions that elicit how a patient is feeling can help uncover the emotion behind what they said.


2. Saying something supportive or affirming to your patient may help them open up to tell you more of their story.


3. Sitting down at the same level as your patient may help convey caring.




This piece was inspired by “Can I Have The Real Doctor?” by Elizabeth Steuber, Academic Psychiatry, 2021.




This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.