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AMA J Ethics. 2017 Apr 1;19(4):357-363. doi: 10.1001/journalofethics.2017.19.4.medu2-1704.

Courage and Compassion: Virtues in Caring for So-Called "Difficult" Patients.

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First-year resident physician in internal medicine at the University of Chicago, and a research scholar at the Hyde Park Institute and coordinates its medical ethics programming.
Josiah C. Trent Professor of Medical Humanities in the Trent Center for Bioethics, Humanities and History of Medicine at Duke University in Durham, North Carolina, and an active palliative medicine physician at both the School of Medicine and the Divinity School.
Assistant professor of medicine at the University of Chicago and the assistant program director for the Internal Medicine Residency Program at Mercy Hospital & Medical Center in Chicago.


What, if anything, can medical ethics offer to assist in the care of the "difficult" patient? We begin with a discussion of virtue theory and its application to medical ethics. We conceptualize the "difficult" patient as an example of a "moral stress test" that especially challenges the physician's character, requiring the good physician to display the virtues of courage and compassion. We then consider two clinical vignettes to flesh out how these virtues might come into play in the care of "difficult" patients, and we conclude with a brief proposal for how medical educators might cultivate these essential character traits in physicians-in-training.

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