This is Part 2 of my series on the learner vs. judger mindset in healthcare.
In Part 1, I shared the story of my tearful patient with menopausal hair loss who came in clutching TikTok screenshots and refusing minoxidil. I showed you how I almost went down the judger path (“Why won’t she just listen?”) and how one moment of shifting to curiosity (“What is she most afraid of?”) transformed everything: her outcome, her trust, and my own wellbeing that day.
That shift took 90 seconds.
But here’s what several of you asked in the comments: “How do you actually make that shift in the moment, especially when you’re running behind and already emotionally depleted?”
Fair question. Because understanding the framework is one thing. Applying it when you’re 20 minutes behind with five more patients waiting? That’s where it gets real.
After 32 years in clinical dermatology, I’ve learned that switching from judger to learner mode isn’t magic. It’s a skill. And like any clinical skill, it gets easier with deliberate practice.
Here are the three techniques I use every single day.
The Practice of Switching (Especially When You’re Running Behind)
Psychologist Marilee Adams talks about “switching” from a judger to a learner. The keyword? Practice. This isn’t a one-time decision; it’s a moment-by-moment choice, especially when you’re under pressure with emotionally intense patients.
Here are the three techniques I teach in WellMedEd:
1. The Pause-and-Name (Your Internal Reset Button)
When you notice judgmental thoughts about a patient spiraling, pause and literally say to yourself: “I’m in judger mode right now about this patient.”
That simple act of naming creates distance and choice.
Then ask: “What would curiosity sound like in this moment?”
Example from the hair loss encounter:
- Judger thought: “Why is she being so difficult about minoxidil?”
- Pause and name: “I’m in judger mode.”
- Curiosity question: “What would help me understand her experience with minoxidil?”
- What I actually asked: “What specifically felt hard about minoxidil for you?”
That single pivot from judgment to curiosity changed the entire encounter. And it took 5 seconds.
Why this works: Naming a mental state activates your prefrontal cortex (your rational brain) and creates what neuroscientists call “cognitive distancing.” You shift from being in the emotion to observing the emotion. That tiny gap is where choice lives.
How to practice:
- Start by noticing judger mode after the encounter. Review your last difficult interaction and identify the judger thoughts you had.
- Progress to noticing judger mode during encounters, even if you don’t switch yet. Just notice.
- Eventually, you’ll catch yourself before you go far down the judger path, and switching becomes quicker.
The goal isn’t to never have judger thoughts. The goal is to catch them faster.
2. The “Story I’m Telling Myself” Technique
When you’re feeling frustrated with a patient, ask yourself: “What story am I telling myself about this patient right now?”
Then: “What’s another possible story that’s equally true?”
Example:
- Story #1 (Judger): “She’s emotional and noncompliant and won’t follow medical advice.”
- Story #2 (Learner): “She’s been dismissed by multiple providers, she’s scared, and she’s learned that advocating for herself means pushing back. She’s actually very motivated; she just needs someone to listen first.”
Both stories may contain some truth. But which one helps you be effective?
Why this works: We don’t respond to patients as they are. We respond to the stories we tell ourselves about patients. And those stories are often incomplete, biased, or based on assumptions rather than facts.
This technique doesn’t mean dismissing your frustration or pretending “difficult” patient behaviors aren’t real. It means recognizing that your interpretation of those behaviors will determine whether you can help.
How to practice:
- When you feel frustration rising, pause and complete this sentence: “The story I’m telling myself is…”
- Write it down if you can (even just in your head counts).
- Then ask: “What are three other possible stories that could explain this behavior?”
- Pick the story that’s most likely and most useful for helping the patient.
Pro tip: The most useful story is usually the one that gives you something actionable to work with. “She’s difficult” gives you nothing. “She’s scared and has been dismissed before” gives you a clear path: validation and partnership.
3. The Curiosity Translation
Every judger question has a learner translation. Practice converting your judgments into curious inquiries, even if you don’t say them out loud immediately.
Common judger thoughts and their learner translations:
Judger Thought
Learner Translation
“Why won’t they just do what I say?”
“What barrier am I not seeing?”
“They’re making this harder than it needs to be.”
“What’s making this feel hard for them?”
“They’re too emotional.”
“What are they afraid of losing?”
“They keep shooting down everything I suggest.”
“What past experience is shaping their response?”
“They’re bringing me internet garbage.”
“What are they trying to tell me they need?”
“They don’t care about getting better.”
“What’s competing for their attention or energy right now?”
“They’re wasting my time.”
“What would make this time feel valuable to both of us?”
The practice: Catch yourself thinking a judger thought. Don’t judge yourself for having it (that’s meta-judger mode!). Just translate it. Out loud if you can. Silently, if you must.
Over time, the learner questions start coming first.
Why this works: Judger questions are closed loops. They don’t lead anywhere except frustration. Learner questions are open doors. They invite exploration, information, and connection. And connection is what changes patient behavior.
How to practice:
- Print this table and keep it visible in your workspace.
- At the end of each day, review one difficult encounter and identify the judger thought you had. Then practice the translation.
- The more you practice, the more automatic the learner response becomes.
Think of it like learning a new language. At first, you have to consciously translate. Eventually, you start thinking in the new language.
The Long Game: Why This Matters More Than You Think
Here’s the truth I learned over three decades: The clinicians who make it to year 30 with their compassion intact, their curiosity alive, and their wellbeing protected aren’t the ones who never had difficult patients. They’re the ones who got really good at shifting from judger to learner mode.
Because here’s what nobody tells you in PA school:
Your most challenging patient encounters will either drain you or develop you, depending entirely on which questions you ask.
When I stayed in judger mode with emotionally intense patients, I left the exam room exhausted, resentful, and telling myself stories about “difficult patients” or “people who won’t help themselves.” That’s the path to compassion fatigue. That’s the path to burning out by year 10.
When I learned to shift to learner mode (to ask “What is she most afraid of?” instead of “Why is she being so difficult?”), everything changed:
Patients became less resistant because they felt heard instead of judged. They actually followed through on treatment plans they’d co-created with me. They came back for follow-ups. They referred their friends.
I became less exhausted because I wasn’t constantly in fight-or-flight mode with every emotional patient. Curiosity is energizing. Judgment is depleting.
Clinical encounters became more efficient (yes, really) because 60 seconds of curious listening prevented 15 minutes of defensive resistance. Learner mode is actually faster than judger mode when you consider the entire interaction.
My diagnostic thinking improved because curiosity revealed information I would have missed in judger mode, such as iron deficiency, scalp inflammation, medication interactions, and the real barriers to adherence.
Here’s what I know now that I wish I’d known in year three:
Clinical expertise isn’t about having all the answers. It’s about getting increasingly comfortable with curiosity, especially when you’re under pressure, running behind, and facing patients who seem “difficult.”
The judger mindset will tell you that uncertainty is weakness, that patient resistance is personal, that emotions are obstacles, and that some people just “won’t help themselves.”
The learner mindset understands that curiosity is courage, that resistance is a form of information, that emotions are essential diagnostic data, and that every “difficult” patient is teaching you something if you’re willing to ask better questions.
After 32 years, I can tell you which approach builds careers that matter and lives that flourish.
Your Turn: Practice Starting Tomorrow
Here’s your challenge for the next week:
Pick ONE of the three switching techniques (Pause-and-Name, Story I’m Telling Myself, or Curiosity Translation) and commit to practicing it with your next three “difficult” patient encounters.
Just one technique. Three encounters. That’s it.
Notice what changes for your patient and for you.
Then come back and tell me:
- Which technique did you try?
- What surprised you?
- What did you learn about yourself or your patient?
Drop your experiences in the comments. Let’s learn from each other.
