Clenched fists, wringing of hands, heavy breathing, furrowed brows- have you encountered such dysfunctional situations with your patients?

 

 

 

 

 

 

Dealing with difficult patients can represent a significant burden in the life of doctors.  In an ideal world, patients will be polite and cooperative and the physicians will be compassionate and caring.However, in the real world, situations are less than ideal for more reasons than one.To turn problem encounters into productive ones, physicians need to navigate such situations with some forethought and a few tactics to come out with sanity and compassion intact.

One of the foremost principle to adhere in such situations is to accept and understand that it is not the "patient" who is difficult, perhaps it is the situation that is making the encounter difficult. And it is the clinician's responsibility to resolve the matter and put the patient at ease.

 While dealing with angry, frightened, defensive or resistant patients it is critical to diffuse the tense situation. The fact is that most of the clinicians face this situation some time or the other.

Here is a quick guide on where to begin

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1.  Identify your patient type and act accordingly

Manipulative patients:  Behavior of certain patients is impulsive as they try to manipulate the physician for their choice of treatment or medication.

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Somatizing patients: Patients of this kind often suffer from anxiety, depression, personality disorders and present multiple, sometimes vague and exaggerated symptoms. Other indications of such patients are multiple diagnostic tests and doctor opinions

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Frequent fliers: Certain patients may deny taking the medication due to the bulk of medicines they are already using. Others may deny due to some sort of prior misguidance or misinformation, in which cases, clarification helps. Few other patients may be too embarrassed to ask their doubts.

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2. Consider working around the common factors that are known to affect the quality of patient-physician relationship.

Sometimes clinician's own attitudes and behavior may lead to such unceremonious situations.

Clinician's Impatience: Recognizing our own trigger points is essential for a smooth patient dealing. Being overstressed or crisis should not be reflected on the patient, which may pave way to unnecessary negative remarks contributing to an unintentional frustrating encounter.

Clinician's Fatigue: Sleep deprivation, strenuous work hours, unexpected emergencies etc.should not impact patient safety. In such situations, consider strategies such as bowing out of commitments and seeking work environments having appropriate limits.

Arrogance or dogmatic behavior: Personal beliefs on medical care should not be overemphasized that may lead to disempowerment in patients and prevent them from opening up. Physicians should try to avoid imposing their belief on the patient if the patient is unwilling to undergo the procedure or adhere to the treatment.

Situational factors

At times, language remains as a barrier to communicate effectively. The physicians must try to spend more time with such patients. Also, working with a trained interpreter rather than family members will help in effective communication.

Presence of multiple people with the patient can inhibit the patient from opening up clearly and completely to the physician. Providing the required privacy, in case the patient requires or demands, can sometimes help both the patient and the physician to arrive at better treatment options.

If not all, certain encounters can be made easier by communicating to the patient with care. Though the difficult encounters with problem patients cannot be avoided, they can be managed with compassion and certain dealing strategies as mentioned above.With more experience and awareness, doctors seem to accept the greater diversity of behaviors in the patients.

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Being prepared with good interpersonal communication skills, and timely identification of factors that contribute to difficult clinical encounters will go a long way in creating a positive difference.