Fall 2022

Members & Publications

What I Learned from Handling Difficult Conversations During Residency



Jason Kessler, MD
PGY3, PHiT Board and Nominating Committee
New York University Grossman School of Medicine, PM&R Program


I remember sitting through countless seminars in medical school listening to instructors teach how to handle difficult conversations and how to identify our cognitive biases when interacting with others. I did not appreciate how applicable those sessions actually were until I started seeing patients as a resident physician where my credentials and background were questioned.

 Two personal examples of these difficult conversations include:

  1. On my pain medicine rotation, I spent nearly two hours with a patient with severe neck and low back pain following a car accident who wanted me to write my notes in a particular way for insurance purposes. She was also adamant that she see my attending physician instead. When informed that she was at a teaching hospital and that she would still see the attending after we were finished, she became frustrated with how I gathered the history of present illness. She would question my medical education when I was not able to answer some of her more complicated questions. The patient eventually left the clinic satisfied once my attending physician finished seeing her, but I was left exhausted and abashed for the rest of the day.
  2. I am a half-Caucasian and half-Chinese American who was born and raised in California. One of the patients that I saw on my Veteran Affairs outpatient rotation would repeatedly ask me where I was from because I looked Asian. When I told him the Bay Area, he would say, “No, where are you really from?” Normally, this would not bother me, but this patient incessantly badgered me until I eventually blurted out China.

 I have spoken to several senior residents and attending physicians for feedback and advice on how to handle these conversations in the future. After some reflection, some of my bigger takeaways include:

-          Have a response prepared, just in case, for these moments: It can be difficult to effectively process emotions and fully grasp what is being said within the context of a patient’s background or clinical situation. We are often too busy to realize what is being said and may stumble a bit trying to come up with an appropriate response to patients. Having a canned response prepared often can satisfy the patient enough while you complete the rest of the patient encounter.

-          Determine whether it is necessary to address this situation now versus later: Would the patient be receptive to a discussion about these biases and stereotypes at this time or would it be better to address this at the next visit (such as when my patient’s pain is better controlled)? Do I have more time-sensitive tasks to finish first?

-          Debrief with your mentors and co-residents: My attending was very supportive of how I interacted with that patient on my Pain rotation. It is nice to know that other providers often experience similar hostility from patients regardless of background or experience. It is nice to know that you are not the only one going through it.

 As I continued to have more difficult conversations with patients, I found myself being less irritated over time. As a resident in New York City, I feel blessed to be learning how to better connect with patients across diverse socioeconomic, religious, and cultural backgrounds.