In medical school and residency we are frequently reminded to be compassionate and empathetic in our patient encounters. Be a good listener and don't rush to judgement are frequent mantras. This is a good rule for practice, but there is a patient type out there for which this approach should be completely thrown out the window.
One such patient came to see me yesterday for chronic shoulder pain. Years of wear and tear commercial fishing had left his rotator cuffs frayed and battered. He came in to discuss his MRI findings and to discuss treatment options including an injection, physical therapy, or referral to an orthopedist. He didn't like any of my ideas.
Now ordinarily the correct approach is to get a broader patient perspective at this point and see what sorts of barriers they have to these options. For example, had they had or known someone who had a bad experience with a steroid injection in the past? Could they not afford time off for surgery?
I learned long ago with this salty old guy he didn't go for any of that. Be too nice to him and he'd consider it patronizing. It would just add to his anger. What he responded better to was his doctor to being brutally blunt and borderline rude to him.
"Well, what do you expect me to do here?" I blurted out. "You know you come to see me wanting my opinion well here it is. You've waited how many years to have this looked at? I don't think this is getting better on its own. I think you should try one of these ideas. If you don't it's your choice, but you ain't gonna get any better doing what you're doing."
Upon getting off my soapbox he sat there in thought with a content look on his face feeling like his doctor really cared enough about him to tell him off. He decided to try a little therapy and if that didn't work he'd think about his other options.
This communication style must be done very carefully as it will anger offend far more than it will work for, but when you find the right patient it can become a quite satisfying patient encounter. Not only does the patient feel well cared for in the end, but I must admit, it can be a therapeutic venting for the physician at times too.