Background: Joy in medicine for many hospitalists is centered around meaningful and rewarding interactions with their patients. Unfortunately, hospitalists commonly face challenging encounters with patients. Hospitalists may consider these encounters challenging when there is a mismatch between time available and time requested by the patient or family, delays of care which are due to system rather than provider-controlled variables, patient and physician goals are misaligned, or when patients are violent or threating [1]. A physician morale survey [2] within the Division of Hospital Medicine at Johns Hopkins Hospital highlighted the impact of challenging patient interactions on physician well-being. Thirty-nine percent of respondents reported that caring for patients with behavioral needs contributed “tremendously” or “a lot” to their stress level on an average day. This is in comparison to 23% of respondents in other sites across the health system. Fosnot et al. found that physicians often feel helpless in these encounters and do not know how to ensure patient needs are met while setting respectful boundaries. The authors recommended development of a safe environment for physicians to debrief after challenging patient encounters [1].
Purpose: To create a formal debriefing process after challenging patient encounters formatted after standard morbidity and mortality (M&M) conferences titled Behavior M&M. Behavior M&Ms provide physicians with emotional support, training, and resources to address future challenging patient encounters.
Description: The Behavior M&M presentations followed the outline of standard M&Ms. The sessions occur quarterly during a one-hour time slot allotted for faculty development sessions. A faculty member is asked to present a challenging case that they recently faced. Examples of case presentations include: a violent patient, a patient requesting intravenous benzodiazepines and opioids that were not felt to be medically indicated, and a patient declining recommended care. The faculty development director is available to review the presentation with the presenter prior to the session. During the session, the presenter spends a few minutes presenting an overview of the patient’s case and timeline leading to the challenging patient encounter(s). The presenter next identifies specific challenges they encountered with the case. Most of the remaining time is spent on a group discussion where faculty are asked to give input into how they would have approached the situation. The presenter closes the session with lessons they learned from the case.An anonymous survey was distributed to Behavior M&M presenters. Based on survey results, the presentations were helpful in helping faculty members learn how to address challenging patient encounters, set time limits with patients in these encounters, and encouraged faculty to seek help from others in caring for these patients. Comments from presenters are attached in table 1.
Conclusions: The burden of challenging patient encounters can be decreased through formal debriefing about these interactions, such as through Behavior M&Ms. Faculty members who gave presentations found the experience helpful and therapeutic. Faculty members learned to more quickly seek help and set time limits when facing challenging patient encounters after participating in Behavior M&Ms. Recommendations for future Behavior M&Ms attached in table 2.
