Emergency Department doctors go through all of that preparation only to end up having some (not all) patients yell at, spit on, insult, despise, and even physically assault them. I once heard a patient scream the most vile string of insulting curses that I had ever heard - at his doctor, who was just trying to calmly ask questions about the man's abdominal pain.
Sometimes, these negative interactions are because the patient has a mental disorder, or is under the influence of a substance. All too often, it's simply because the patient is a mean, nasty person who feels like he's got all the control. Somehow, there is a sense of entitlement that surfaces in some patients who go to the ED for care, and I've never understood it. It seems like when you're in the most need, that's when you would be the most polite, in the hopes that your doctor would then take better care of you. I understand the urgency that can come when you're scared you might die, or you're in intense pain, but what I'm referring to is something different. I'm talking about the patient that pees on the floor because he doesn't want to walk to the bathroom or ask for a bed pan, or the woman that screams at her nurse when denied a beverage until after her test results. These are the patients that nobody wants.
When I think about the possibility of becoming an emergency physician, I think interactions with people like these would be one of the hardest parts of the job. Being the one in charge and shouldering responsibility, thinking on my feet, doing difficult procedures, or filling out tedious paperwork - those tasks I think would be easier to handle. Staying calm and treating my patient with courtesy and respect while being yelled at, slapped, or spit on... Not so much. Losing a patient and delivering bad news would definitely be the hardest part overall, but I think dealing with vile and disrespectful patients while keeping my cool would be a close second.
This was all prompted by an article (linked below) I read earlier today by Dr. Jay M. Baruch, MD. He explains the situation well when he writes, "The emergency department might be the only sphere of human exchange where one party—patients (and sometimes family)—are permitted to insult, threaten, and even spit at the very people on whom they depend for help, while the offended parties—physicians, nurses, and other health care providers—must not only tolerate the abuse, but treat their tormentors." He goes on to tell about a specific interaction and his reaction. It's well worth the read: Dr. Douchebag - A Tale of the Emergency Department.