There is a mythos surrounding the "patient no one likes" in most hospitals. Attendings tell stories of them in the same manner grandfathers tell ghost stories, and with the same purpose: to excite and terrorize the inexperienced youngsters. But when you actually meet a ghost, or a "patient no one likes," the experience is very real, less exciting, and actually more terrorizing. At least, that goes for the patients, I wouldn't yet know about ghosts.
Today, though, I met the very first patient I don't like. This woman has everything wrong. She is one of the unfortunate souls whom modern medicine can keep alive, and on her own, but just barely. She can't walk well, breathes deeply at rest and is beginning to feel the aches and pains accumulated over seven decades at the bottom of the social order. As is common in many of her socio-economic class though, she has a keen, even overactive sensitivity to condescension. Hence, if I speak to her in layman's terms, she gets disgruntled, and if I use medical terminology, she won't understand and feels I am "acting better than her." The encounter was doomed from the start probably, but things got really sour when I insisted (rookie mistake) that West Nile Virus does not, in fact, cause weeping ulcers on a person's ankles. She told me "well I beg to differ young man, because I wear white socks." At this point, I think the quizzical expression I was wearing said far more than my meek question about what white socks had to do with West Nile. She elaborated "I need to wear them because of the things West Nile puts on my legs. They get worse in the spring when there's more West Nile around. The doctor gives me something for them then."
Here is where the Zen Master is practising the art of medicine so well. Instead of countering her, which leads no-where very quickly, he has prescribed her a harmless lotion for her sores. This does actually treat them, and though she remains convinced she has "West Nile legs" she gets treatment despite her error. He emphasized to me the importance of never telling a patient like this anything you aren't positive on, because at some point in the past, someone told her she has this condition, and she has latched onto it as an explanation for what she can't change about herself. The real reason for her sores is that she has diabetes, has smoked for 60+ years, and has ruined the circulation in her legs. But the "West Nile cream" is all she really needs at this point.
The Zen Master is a really good doctor. Despite his unassuming manner, his constant mention of what he doesn't know, and his cynical commentary about patients like this, he considers closely the cost of what he orders, he considers the patient as a whole, and he takes into account the quirks of human nature. And he is always learning new ways to improve.