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Dealing with Difficult Patients

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Lecture on Dealing with Difficult Patients

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Dealing with Difficult Patients

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  1. Dealing with Difficult Patients Aileen B. Pascual, MD, FPAFP 12 July 2012

  2. Think of a difficult situation… • What made it difficult? • What was the outcome you were hoping for? • What actually happened? • What would have made it go better?

  3. What makes an interaction difficult? Fear – of the unknown, of not knowing how the other person will react, of hurting someone’s feelings or of feeling hurt Conflict – few people enjoy conflict and most go out of their way to avoid it Surprise – catching someone off guard can make an otherwise smooth interaction difficult Change – interactions involving having to make a change often make people feel uncomfortable

  4. Why we avoid difficult interactions We’re afraid we’ll make the situation worse We don’t want to feel bad, and we don’t want others to feel bad We may hear things about ourselves that we don’t want to hear We, and the other person, may get emotional We don’t know how the interaction will end, and we fear the consequences

  5. The label “difficult” is subjective • Interpersonal in nature • Based upon discomfort with: • What has happened • What might happen

  6. “Difficult” is different for different individuals • Someone labeled “difficult” by a person may not be seen as quite so difficult by another • Differences in expertise and experience account for differences in perception

  7. “Difficult” is a function of the relationship • Two people • How they interact

  8. Unfortunately… impossible people exist. • You will encounter them. • You can’t avoid them. • You can’t fix them. • You can’t make them like you. • You can’t beat them. • They may not want your help

  9. How to minimize difficult interactions • Know your purpose • Frame your message • Use an assertive approach • Use cooperative language • Use active listening skills

  10. Responding ASSERTIVELY(DESC vs. DISC) • Describe the situation • Express your feelings • Specify the change you want • Consequence “I have been coming here for PT to treat my pain. I feel frustrated that the pain is still there and worse, I have to stand in line. May I at least have a place to sit, so that I can be more comfortable as I wait?” • Describe the situation • Indicate problem the behavior is causing • Specify the change you want • Consequence “I have been coming here for PT to treat my pain. There’s no improvement & waiting in line further adds to my pain. May I at least have a place to sit, so that I can be more comfortable as I wait?”

  11. Active Listening Skills • Attending • Bracketing • Leading • Reflecting • Probing

  12. Doctor-Patient Relationship

  13. Good physician communication can lead to: • increased patient satisfaction • increased health care professional satisfaction • improved patient health outcomes • decrease in complaints and lawsuits

  14. Clinicians can have fewer“difficult” relationships by: • Discovering what factors contribute to the label “difficult” • Exploring techniques that can lead to more satisfactory relationships • Experimenting with new skills

  15. Factors that influence doctor-patient communication • Patient-related factors • Doctor-related factors • The interview setting (environment)

  16. Difficult Patients “patients who are medically challenging, interpersonally difficult, psychiatrically ill, chronically medically ill, or lacking in social support.” Adams J, Murray R: The General Approach To The Difficult Patient. Emerg Med Clin North Am 1998;16:689-700.

  17. Patient characteristics • Angry, defensive, frightened, resistant • Manipulative • Somatizing • Grieving • “Frequent fliers”

  18. When confronted with difficult patients… take HEART  • Hear them out. • Empathize • Apologize for the inconvenience. • Respond appropriately. • Thank your patient for bearing with the inconvenience.

  19. Physician characteristics • Angry or defensive • Fatigued or harried • Dogmatic or arrogant

  20. Physician self-care • Ensure personal well-being • Know trigger issues • Know your limits • Bracket. Bracket. Bracket.

  21. Situational factors • Language and literacy issues • Companions during consult • Breaking bad news • Environmental issues (setting)

  22. Coping with Difficult Patients • Avoid being judgmental • Be patient, tolerant • Get good history to understand patient • Use direct communication • Humor • Selective personal disclosure

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