Do Physicians Have an Ethical Duty to Repair Relationships with So-Called “Difficult” Patients?

Abstract

This essay argues that physicians hold primary ethical responsibility for repairing damaged patient-physician relationships. The first section establishes that the patient-physician relationship has an important influence on patient health and argues that physicians' duty to treat should be understood as including a responsibility to repair broken relationships, regardless of which party was "responsible" for the initial tension. The second section argues that the person with more power to repair the relationship also has more responsibility to do so and considers the moral psychology of pain as foundational to conceiving the patient in this case as especially vulnerable and disempowered. The essay concludes with suggestions for clinicians to act on the idea that a healthy patient-physician relationship ought to lie at the center of medicine's moral mission. CaseJohn is a third-year medical student on his first day with a new service during his surgery rotation. On this particular morning, John is going on rounds with the chief resident, Dr. M, and an intern, Dr. S. As the team walks down the hall to the next room, John quickly glances over his rounding sheet for a 48-year-old man, Mr. C. Mr. C had a toe amputation three days ago and suffers from chronic pain and diabetes mellitus type I. He also has a history of using opioids, and his pain medications are being carefully controlled in the hospital.Before they enter the room, the intern Dr. S softly says to Dr. M, "Hey, just as a heads up, I heard this one was feisty last night. Apparently, the attending physician came down hard on his request for more analgesia. The patient was not happy with the refusal and gave the nursing staff a lot of trouble." Dr. M responded, "I heard about that. But he's always been difficult; I saw him in clinic last month." The team then enters the room.

Ethical Approach for Managing Patient–Physician Conflict and Ending the Patient–Physician Relationship

“…Although physicians bring expertise in medicine to the patient-physician relationship, such knowledge or authority is best managed and shared with patients by acknowledging that patients are the experts in their own lived experience, goals, and values. Physicians have an ethical duty to work toward conflict resolution to restore a therapeutic relationship between themselves and their patients (7,8).…”