If you don't build a reputation...

... one will be built for you.

And mine currently seems to be "the negotiator."

My colleagues are under the impression that I am able to "handle difficult patients" (and maybe that I enjoy it). 

No comment. 

But if it's true, it's because of a principle that I'm extremely grateful to have learned in medical school (but really resented at the time) called open-ended questioning, which really helps with conflict resolution.

The idea is simple. Ask an open ended question first, like the go-to in my current hospital... "What's up?" After that, the patient is usually exasperated enough to just tell you what's on their mind. If not, it could be because sometimes people don't want to share, or actually don't even realize, what is their PRIMARY concern - whether it's their illness or their dinner or their job, mother, etc. In those cases, you might have to have an actual conversation and listen until the real issue at hand pops up, even if it's what we call a "secondary gain" - something that the patient is getting besides medical help, be it financial, social, familial, whatever. But more often than not, people will just tell you what they want if you ask the right way. Like you're trying to find out what they want. Like you want to help.

Now, if I'm called in to defuse a "situation," the patient already knows that I'm probably some sort of problem-solver, and often immediately relates the problem. In this way, the reputation essentially builds itself once it's started. So I already have an advantage now knowing exactly what the patient's concerns are. Then, I simply address them. If they're reasonable, we can usually get somewhere. 

If the patient decides (or their condition forces them) to be unreasonable, I generally feel bold enough to just tell them so. It takes a little bit of confidence to do, and you have to gauge if the person is ready to hear that (many aren't and I'm often wrong). But if you get to an impasse doing that, THAT's when I feel the patient is actually, truly being "difficult." And not all problems have solutions. Sometimes, it's just a bad situation. Or sometimes, a patient is just a difficult person. As a doctor, you encounter many of both. Dr. Kleenex helps with the former, and the latter... well, people sometimes just want to be heard and after getting it out they feel better.

If it just takes some open-ended questioning to figure it out, it often means that the patient was not being difficult, but in fact the doctor/nurse/team was. We often grossly underestimate how confused, scared, anxious, and uneducated our patients are about their illness (I'm including myself in this). Or how much time the patient wants to spend with us. Or how they couldn't care less about the diagnosis or medical jargon and just want to leave the hospital and get on with their lives. These are the times when listening helps.

Unfortunately, many doctors are not naturally great listeners. We're a selectively assertive group of people, who mostly had to push hard make it into this field. We feel independent because of our accomplishments, like we can solve anything on our own. We feel like we know all the answers, because that's what we are trained to do. Thankfully, med schools are starting to teach students how to listen. I couldn't stand it at the time, but I must admit it's coming in handy. My favorite lesson of intern year was that when rounding, every extra minute you spend in a patient's room making sure they are comfortable and their concerns are all addressed, saves you roughly an hour's worth of trouble later on.

Also, your patients will like you and think you're all kinds of awesome. But let's call that a "secondary gain."