Difficult patient and

Dealing with Difficult patient

Definition
• Difficult patient is the one with whom the physician has touble forming
an effective working relationship.

• difficult patient”
• “hateful patient”
• angry patient”
• “heartsink patient”
 Difficult patient
As a health care professional, you
come in contact with many people
on a daily basis. Every patient is
unique and each person has their
own personality. It’s great when you
can build a good rapport with
patients and everything runs
smoothly, but unfortunately, there are
patients who can make your work
more challenging than it already is.
• Difficult patients can be needy, demanding, and question everything you
do.
• They take up a great deal of time and energy, and can put you in a testy
mood very quickly if you don’t know how to deal with them.
• Here are a few tips that may help you create better relationships with
patients…
• Is your behavior and way of communicating not up to par?
• Perhaps your lack of communication is making the patient question your
actions.
• Work On Communication Skills Spend an extra moment or two with the
patient to really listen to their needs and make sure to answer their
questions thoroughly.
• If this person in front of you was a loved one, how would you treat
them?
Difficult Patients

• Physchotic patient • VIP patient

• Depressive patient • Hypocondrial «the worried well» patient
• Talkative patient • Somatizing patient
• Withdrawn patient • Isolated patient
• Bereaved patient
• Angry patient
• Demanding patient
• Manuplative patient
• Reluctant patient
Difficult doctor
• Doctor in a hurry
• Authoritarian doctor
• Passive doctor
• Angry doctor
• Alien doctor
• Doctor who have social or psycological probems,
• Doctor who have burnout syndrome
Difficult communication

• Language differences
• Social class differences
 Physician factors
• Physicians' own attitudes and behaviors, including the following, may also
contribute to difficult encounters with patients.
Angry or defensive physicians
Physicians who are burned out, stressed and generally frustrated over near-term
crises or long-term concerns are more likely to react negatively to patients, not
just those with characteristics that may contribute to a difficult encounter.
Recognizing our own trigger issues and knowing what personal baggage we bring
into the exam room can be valuable.
 Physician factors
Fatigued or harried physicians
Most of us have been overworked, sleep deprived or generally busier than we
needed to be at one time or another. “Over commitment” is a closely related
phenomenon that is all too common among high-achieving professionals. It is
important that we be sensitive to the impact of physician fatigue on medical
errors and patient safety and set reasonable limits for ourselves.3 Consider
these strategies: Diplomatically bow out of commitments, delegate to others
as appropriate and seek work environments that value setting appropriate
limits.
 Physician factors

Dogmatic or arrogant physicians.

Each of us has things we feel strongly about. Personal beliefs and values, as
well as our beliefs and values about medical care, can lead us to
overemphasize our own beliefs and emotions in ways that disempower
patients or prevent them from providing us with adequate information about
their care. Our own baggage may also prevent us from assessing that
information without bias. Identify your trigger issues and avoid situations in
which your beliefs may inappropriately close off adequate exchange of
information and the shared decision making that is critical to a healthy
patient-physician relationship.
 Situational factors

Sometimes difficult encounters have more to do with the circumstances

surrounding the encounter than with the people involved. You should be
ready to address the following challenges when they arise.
Situational factors
Language and literacy issues
As the United States develops a more diverse population, family physicians
increasingly find themselves needing to communicate with individuals whose
primary language is different than their own. Try to allow extra time for these
encounters. Whenever possible, work with a trained interpreter rather than
trying to communicate through a patient's family or friends. Ensure that the
interpreter translates everything that is said rather than “editing” the
conversation. Direct your eyes and speech toward the patient rather than the
interpreter. Working across cultures requires sensitivity to different beliefs about
health and illness, religious issues and gender issues. You may not be able to be
“culturally competent” for all people, but your goal should be to remain
“culturally sensitive” in all situations.
 Situational factors
• Multiple people in the exam room. As many as 16 percent of adult
patients have a companion present during ambulatory medical
appointments.4 This phenomenon requires thoughtful assessment of the
situation and mindfulness of the patient's needs. Consider these issues:
Does the patient want the other individual in the room — for the
history and the physical exam? Is there a need to talk with the patient
alone? Will the third person be involved in health care decisions, or are
there cultural reasons for him or her to be present? Is there any evidence
that the third person is forcing the patient to acquiesce to his or her
presence?
 Situational factors

• When patients have companions in the exam room, be sure to speak directly
to the patient, avoid taking sides in any conflict, and evaluate all parties'
understanding of the information and the management plan.
Environmental issues
Physicians often overlook the fact that their surroundings may increase the
likelihood of a difficult patient encounter. If the environment is noisy, chaotic or
doesn't afford appropriate privacy, patients, providers and staff are all more
likely to be unhappy or unpleasant. These factors can often be alleviated with
a bit of forethought.
 Situational factors
Breaking bad news
When it is necessary to give patients information that will be difficult for them
to hear, preparation is critical. Know who will be present for the discussion,
allow adequate time and privacy, and review the clinical situation. In the early
stages of the encounter, assess what the patient already understands or
believes about the situation and how much more information he or she wants.
Disclose the news directly, allowing adequate response time for the patient and
others in the room to experience their emotions and process the information.
After giving the news, discuss the implications, offer additional resources, agree
on next steps, summarize the discussion and be certain to arrange for follow-up.
 The Difficult Patient Interview – steps
1.Distinguish the the difficult patient interview
Physicians tend to blame patients for mostof the difficult
interactions they experience, and patients blame doctors.
Unfortunately, it does little good to blame each other. Although
either doctor or patient can remedy a dysfunctional interaction, it
is usually the doctor who wields the most influence and has the
best chance to repair the interaction. The most critical point is to
recognize the difficulty early. You may be tipped off to the trouble
when you notice repetition, interruption, or stereotypic behavior
on the part of yourself or the patient.
2.Pause the interview
Once you are aware of that something is going wrong, pause,
step back, and think about the matter. Acknowledge to yourself
that you are having difficulty and probably also some feelings
about it. For many of us, some feelings happen so fast that we
act on them before thinking. This causes unwanted behavior.
So, explaining this silence to patient provides relief for both
sides.
3. Put forward the problem
Be careful. You are not diagnosing your patient’s problem (for
example a personality problem or lack of social support, even
though these may be true). At this point, you are naming a
problem in the doctor-patient interaction itself. Check to see if
the disruption stems from a strong affect in the patient: anger,
sadness, fear, or the feeling of caught in a bind. Sometimes
something in the interview environment becomes a distraction.
4. Share the problem with the patient
In acknowledging your discomfort, you are asking the patient
to be a partner in resolving what seems to be an interactional
problem. Sharing the problem may be quite simple and fairly
brief. Avoid blaming or name calling. In fact, you may be able
to own the entire problem and ask your patient for help.
5.Propagate solutions
Resolving what seems to be an interactional problem. If the
problem is caused by the your behaviour, you should evaluate
the justness of patient and apologize.
6. Show empathic approach towards the patient’s emotion/feelings
If the disruption stems from a strong affect in the patient
(anger, sadness, fear, or the feeling of caught in a bind),
address this feeling first, using empathic responses.
Understanding patient’s feelings doesn’t mean that you accept
patient’s behaviour and rigthness. Saying the patient to
understand his/her behaviour is the last action, after that there
is no need any word or behaviour. In many cases, all the
expectation of patients is to see an understanding of their
feelings