Dealing with the difficult patient

Abstract

Dealing with difficult patients can represent a significant burden in the life of doctors. It is more productive, however, to view this burden as a product of the interaction between doctor and patient, for which both have a responsibility, rather than attributing any problems encountered to shortcomings of the patient alone. There is a significant risk in such situations of potentially harmful over-medicalisation. It behoves doctors, therefore, to try to prevent such problems becoming established, or make some attempt to rectify matters if they have already become so. Much is known about the factors that contribute to successful and unsuccessful clinical transactions. The awareness of what doctors bring both as professionals and as individual people to this interaction, will count as much as the practical clinical efforts made towards helping patients.

Student’s Perception of Missed Care: Focus Group Results

“…Participants also described feelings of frustration, anger, helplessness when encountering difficult clients, as well as labeling clients in such situations. Similar findings have been reported by others [32]. [28] explored strategies used by 234 clinical nurse specialists when caring for patients involved in "difficult" clinician situations.…”

How Respected Family Physicians Manage Difficult Patient Encounters

“…Many of these behaviors and medical problems have been previously described in the literature. 6,7,12,15,[33][34][35] These patient qualities tend to clash with physician traits that encompass who they are-their professional identity and personal self-worth, their time management skills and confidence, and even their comfort with patient autonomy and trust in the patient. 27,36 Especially when physicians feel their professional identity or personal self-worth is threatened, they may feel a loss of control.…”

“…14 Instead, management advice is given anecdotally 3,4,16 or from an educational or psychological perspective. 13,15,17 Despite all this advice, practicing physicians lack a "best practices" method of managing difficult patient encounters. A first step in developing a "best practice" is to develop a conceptual model, based on input from stakeholders, such as physicians.…”

“…6,8 From these, causation models have been developed that generally contain three or four interacting components: patient characteristics, physician characteristics, the environment and relationship skills. [13][14][15] Studies examining physician characteristics have found that physicians with lower job satisfaction, 1 less experience, 7 and poorer psychosocial attitudes 6 describe more difficult patient encounters. Fewer studies have studied how physicians actually manage difficult patients.…”

The difficult patient' as perceived by family physicians

“…1 These patients visit their doctor more frequently than average, with a variety of acute and chronic problems, receive more prescriptions, have more tests run and are referred more often to obtain a 'second opinion' or counselling from various specialists. 2 Some call them 'heart sink' patients. 3 Many of these patients have a 'thick file' in the doctor's office.…”