Jading

This post is as much a request for feedback from experienced professionals as it is a warning to those who will be PA, NP, or medical students reading these words later on. 

In several of my rotations I have noticed that some of the more seasoned providers have become rather presumptive about some of our patients.  Granted, they know our patients better than I do and I am still the student so I have to learn to approach difficult patients with caution.  But the providers I have worked with that I am talking about herein are providers who have made assumptions about our patients like, "He just wants pain meds," or, "She's just looking to get high."  It appears from my perspective that these providers are becoming jaded with their experiences, as if they've been burned by drug seekers too many times to be able to remain objective and avoid jumping to conclusions.  I say this because I, in my naivety, have approached them with a blank mind (quite literally sometimes) and have found some pretty profound pathology - a patient who I suspect of having an ACL tear, or a patient who has significant osteoarthritis, and several others. 

To the experienced providers I ask this: is there a method by which you have avoided this pitfall so as to maintain functional ability with difficult patients?  It is my short experience that if we can maintain a sensitive approach to even our most difficult patients, then we will be able to treat them more effectively.  Am I wrong? 

To those students who are coming after me, I offer you this from my experiences (stop me if you've heard this story): many months ago I was working in the ER when a patient bounced back from earlier that day.  This was a young girl who had been complaining of back pain but now she was coming in with severe abdominal pain.  In passing a nurse commented about her prior visit to the ER and the likelihood that she had, "Just not gotten what she wanted."  I bought into that thinking about her right away and it was reinforced as I watched her roll by on the stretcher writhing in pain.  As I went in to examine her I was unimpressed by her pain given that she reacted excessively to every test that I did - minor pressure on her belly elicited near screams.  She had no other symptoms that I could find.  I presented the case to my preceptor who taught me a valuable lesson that day - he said, "Yeah, it could be a bounce-back because she didn't get the meds she wanted... Or she could have something wrong in her belly, so let's look."  He ordered an ultrasound and found a GIANT ovarian cyst, reaching nearly up to the patient's ribs.  As soon as I heard that I hung my head in shame... I had made a bad assumption based on very little evidence, and I was dead wrong.  I would have been infinitely better as a provider if I had not assumed as much as I did, and I hope that I never forget the shame I felt that day - it was a good teacher.