We have a monthly Balint- style practice meeting. A Balint group is a group of clinicians who meet regularly and present clinical cases in order to better understand the clinician-patient relationship. Our group is moderated by a real, bona fide psychologist, and serves as a sort of therapy… I think a lot of our practice satisfaction is due to that group.

This week, as several of my colleagues had read my recent posts, we discussed frustrating cases. What clinical scenarios make us wring our hands? What pulls our trigger?

It’s so funny that we all have our own Kryptonite. For one person it’s the anorexics, for another it’s the obese, for another it’s the noncompliant diabetics.

In every one of these meetings, no matter how hard our psychologist colleague-mediator tries to hold us to discussing our feelings and exploring the doctor-patient relationship, we all get overly excited about throwing our clinical advice around. Well, have you tried this technique with the eating disorder patients or This type of counseling has worked well for me for the diabetics…

We all so sincerely want to help. Everyone. Isn’t this why we went into medicine…

But, it struck me that what we kept burying and avoiding, and what she kept trying to bring our type A med student personalities back around to face, was our own feelings. Our frustrations, anger even, when dealing with whatever it is we find difficult to deal with.

Someone will slump forward and admit: I’ve been working with this alcoholic patient for a decade and I’ve just about given up….I don’t know why they keep coming back…I have nothing left to offer… 

Someone will lean forward eagerly and offer: Well, in those cases what I’ve done is…

And our psychologist will firmly interrupt: Wait! First, how does it make you FEEL?

In this most recent meeting, it felt so good to hear that other providers get frustrated as well, even angry. Other providers beat their heads when faced with certain resistances. We’re all human. We’re not impervious to emotions in the exam room…

And that’s OK, especially when we’re willing to face that and learn from it and move forward. Right? We’re not robots, impersonal, metal. Yes, we face each case with our arsenal of hard-earned knowledge, but we also call in our upbringing, opinion, experience, religion… There’s no way around it. It’s a reality.

I will always cringe inwardly when met with the “I want to get healthy, but I just can’t…”

I can answer that complaint with more compassion, be more thoughtful, and craft my responses more carefully. I can use Goalification; I can employ Motivational interviewing techniques; I can put the responsibility back on the patient without getting caught up in their struggle (see last post). But I’ll still inwardly cringe…

How does that make you feel?