Good Patients and Bad Patients: How Occupational Therapists View Their Patients/Clients

Abstract

Many studies have highlighted how health professionals tend to categorise their patients in terms of moral evaluations, in particular perceiving patients as 'good' and 'bad'. This article reports on a qualitative study which explored how occupational therapists experienced their patients/clients, investigating what social evaluations were made. Nine occupational therapists were interviewed using a relatively non-directive, phenomenological approach. Although the therapists were reluctant to stereotype their patients/clients, the use of moral and social evaluations was widespread. 'Good' patients were warmly responsive and made the therapists feel valued and effective. 'Bad' patients were manipulative, threatening and resisted change. An additional category of 'difficult' patients emerged which reflected the therapists' ambivalent responses to this patient/client group, who were experienced as positively chal!enging but hard work. The discussion emphasises how social evaluations are complex and involve mUltiple meanings which emerge in different contexts with different individuals.

Reconstructing Gloria: A Narrative Analysis of Team Meetings

“…Gloria's story is a common script used by health care workers to characterize patients. She is what has been referred to as the "bad," "difficult," or "unpopular" patient (Findlay, 1997;Griffiths & Hughes, 1994;Johnson & Webb, 1995). The analysis presented here is part of a larger study of a geropsychiatric team that focused on understanding the culture of the unit and the role that the mission of the unit played in shaping the actions of the team (Crepeau, 1994b).…”

Nurse Bait: Strategies Hospitalized Patients Use to Entice Nurses Within the Context of the Interpersonal Relationship

“…They were acutely aware of the difference between "good patients" and "bad patients." Patients much preferred to be labeled an "easy patient" because the alternative, the "bad" or "difficult" patient, carried negative consequences they wanted to avoid (Breeze & Repper, 1998;Carveth, 1995;Finlay, 1997).…”

“…The unethical social labeling of patients as "difficult" or "bad" has been shown to have negative effects on nurse-patient relationships and on outcomes of care (Carveth, 1995;Erlen & Jones, 1999;Finlay, 1997). Therefore, patient behavior or the presentation of self (Goffman, 1959) can have a direct effect on the quality of care that that patient receives.…”

“…Nurses who labeled patients as "difficult" often avoided or distanced themselves from these patients (Breeze & Repper, 1998;Carveth, 1995;Finlay, 1997). Such distance has been shown to result in less supportive nursing care, such as responding less promptly to patient requests for assistance, providing less privacy, informing the patient to a lesser amount, providing fewer comfort measures, and using the patient's name less often (Carveth, 1995).…”

Icelandic occupational therapists' attitudes towards educational issues

“…Their findings and recommendations fall into different areas relevant to this discussion. These are value of theory developments (Van Deusen, 1981;Barris and Kielhofner, 1985;), clinical reasoning skills (Strong et al, 1995), factors contributing to leadership (Scott, 1985;Burke and DePoy, 1991;Schemm and Bross, 1995), factors influencing the development of master clinicians (DePoy, 1990), knowledge of theories (Javetz and Katz, 1989;Munoz et al, 1993), factors leading therapists to cease practice (Rugg, 1996) or to become administrators or clinicians (Bailey, 1988), whether attitudes towards theory developments are related to educational level (Van Deusen, 1985, 1986, perceptions about occupational therapy education (Fleming and Piedmont, 1989), the move from diploma to degree level (Gape and Hewin, 1995), involvement in research activities (Taylor and Mitchell, 1990), the role of occupational therapy and the practitioner (Adamson et al, 1994;Schwartz, 1995a, 1995b;Clark et al, 1995;Brotherton, 1995a, 1995b;Engquist et al, 1997;Moll and Cook, 1997;Vogel, 1991), professional productivity Mann, 1980a, 1980b;Gilkeson and Hanten, 1984;Clark et al, 1985;Storm, 1990), efficacy of one method for teaching reasoning skills (Neistadt, 1992;Neistadt and Smith, 1997), speciality choice in occupational therapy (Ezersky et al, 1989), and experiences occupational therapists have in their practice (Finlay, 1997) …”