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

Think Positive!


Reframing negative thoughts about my inebriated patient would have helped me to care for him with more compassion.    

Connecting with Patients | July 25, 2022 | 2 min read

By Joan Naidorf, DO

“We just put a new patient in room 10,” the paramedic said. 


I walked over to find a familiar mop of brown hair, face down on the gurney, reeking of alcohol and body odor. I rolled my eyes and groaned. This was the same guy I’d seen the night before in a similar condition. We checked him out, sobered him up, and sent him away with some referrals and medications.  


We didn’t like taking care of him and viewed all of our efforts as futile. His underlying conditions of substance abuse disorder, unemployment, and homelessness could not be adequately addressed in the setting of the emergency department. It seemed like he was purposely making himself sicker and I felt frustrated.  


Clinicians often develop resentments or frustrations for some patients, particularly those we consider “difficult.” We don’t like to acknowledge this as it feels unprofessional and contrary to the oaths we took when we graduated from medical or nursing school.  


During our training, many of us hear some clinicians use derogatory and demeaning language about patients who seem uncooperative, self-destructive, and/or disagreeable. Thinking about specific people and types of patients in negative ways can become a terrible and habitual way of thinking. 


Our patients with antagonistic and challenging behaviors don’t have to change for us to feel better about them. We can actually change the way that we think about them. Awareness of the predictable behaviors of “difficult” patients heightens readiness and allows us to choose our thoughts with intention.  


If I could have generated a more positive thought about my inebriated patient, I could have felt more compassion and curiosity about him. Did he have an injury that I didn’t consider because I thought he was “just drunk again?” Was he a son or a father?  Was he just a complicated human like the rest of us? 


Intentionally creating better thoughts about “difficult” patients will lead to positive emotions and better results. What we think about patients really matters. With some well-chosen questions and answers, we can move to a kinder and more compassionate place that keeps us excited about caring for patients. 


To learn more, check out my book: “Changing How we Think About Difficult Patients: A Guide for Physicians and Healthcare Professionals.”







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