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Dealing with difficult patients

Dealing with difficult patients. A psychological approach. overview. Types of Difficult Patients Behaviors and Reasons What You Can Do. Types of difficult patients. What doctors & patients want. Patient. Doctor. Compliance Respect Continuity Involvement Preparation and Curiosity.

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Dealing with difficult patients

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  1. Dealing with difficult patients A psychological approach

  2. overview • Types of Difficult Patients • Behaviors and Reasons • What You Can Do

  3. Types of difficult patients

  4. What doctors & patients want Patient Doctor Compliance Respect Continuity Involvement Preparation and Curiosity • Eye Contact • Partnership • Communication • Time • Appointments

  5. What makes a good doctor? • Good communicator and listener • Organization and conscientiousness • Helps patients feel cared for • Curious • Collaboration • Advocate for patient • Empathetic

  6. The noncompliant patient BEHAVIOR WHY? Do not understand treatment plan Do not understand scope of diagnosis or severity Not committed to treatment plan Not ready to face reality Life stress • Does not follow instructions or treatment • Does not take medications • Misses appointments

  7. What do you do? • Partner with them in the treatment plan • Miracle Question • Foot-in-the-Door Phenomenon • Door-in-the-Face Technique

  8. Rude, Angry, or Irritable Patients BEHAVIOR WHY? Fear Problems at home, work, school, finances relationships, etc. Rude staff Poor coping skills Result? Poorer quality in treatment • Upset • Short and rude with you or staff • Anxious • Easily annoyed • Dismissive of you and/or treatment

  9. what do you do? • Remain calm (easier said than done) • You are a safe person • Avoid the argument • Agree when you can; a drop of honey • Team up with patient

  10. Manipulative patients BEHAVIOR WHY? Attention-seeking Need to feel important Limited social contact with others Captivated audience Personality disorder • Doctor shopping • Attempt to make you feel guilty • Lack of boundaries • Looks for weaknesses • Attempts to get doctor’s notes, handicap tags, unneeded prescriptions • Refuses responsibility

  11. What do you do? • Remain calm, eye contact, level tone • Consider environment and background • Maintain boundaries, focus on reason for visit • “What is your main reason for coming in today?” • “Great, let’s focus on that for today.” • Ask probing questions: • “Does what you are asking me sound fair?” • “Are you asking me or telling me?”

  12. What do you do?

  13. Know-It-all BEHAVIOR WHY? Personality disorder Elevated sense of self-worth Insecurity, fear of closeness Feel connected to others through arguments Praised too much as a child A need for importance • Persistent questioning of treatment plan • Constant research and internet use • Disregard treatment advice

  14. What do you do? • Take control, prioritize • Be prepared, create handouts • Compliment their strengths but do not overpraise • Encourage online research…from credible sites • Avoid arguing

  15. Questions?

  16. Reference Links British Medical Journal: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1126182/ Canadian Society of Intestinal Research: https://badgut.org/information-centre/a-z-digestive-topics/8-things-doctors-want-patients-to-do/ Consumer Reports: https://www.consumerreports.org/cro/2012/04/what-doctors-wish-their-patients-knew/index.htm St. George’s University: https://www.sgu.edu/blog/medical/what-makes-a-good-doctor/ Institute for Solution-Focused Therapy: https://solutionfocused.net/what-is-solution-focused-therapy/ Journal of Business and Psychology: https://www.jstor.org/stable/25092230?seq=1#page_scan_tab_contents Freedman & Fraser and Cialdini: https://www.simplypsychology.org/compliance.html Journal of the Royal College of Physicians: http://www.clinmed.rcpjournal.org/content/15/6/541.short Pediatrics: https://pediatrics.aappublications.org/content/139/2/e20162305?sso= 1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3A%20No%20local%20token Psychology Today: https://www.psychologytoday.com/us/blog/in-flux/201610/9-classic-traits-manipulative-people

  17. Reference Links Continued Cleveland Clinic Journal of Medicine: https://www.mdedge.com/ccjm/article/141597/mental-health/patients-challenging-behaviors-communication-strategies F. Diane Barth, LCSW: https://www.psychologytoday.com/us/blog/the-couch/201312/what-s-the-best-way-handle-know-it-all Harvard Business Review: https://hbr.org/2017/10/how-to-deal-with-the-know-it-all-in-your-office American Management Association: https://www.amanet.org/articles/how-to-deal-with-a-know-it-all/ Physician’s Practice: https://www.physicianspractice.com/know-it-all-patient Practical Resources for the Mental Health Professional: https://www.sciencedirect.com/science/article/pii/B9780120884162500062 Dr. Kamilla Porter: https://www.gponline.com/consultation-skills-deal-manipulative-patients/article/937861 Nurse Lynda Lampert: https://www.ausmed.com/cpd/articles/how-to-handle-difficult-patients Communication Coach Preston Ni, MSBA: https://www.psychologytoday.com/us/blog/communication-success/201406/how-spot-and-stop-manipulators Douglas A. Kemerer: https://www.americannursetoday.com/manage-manipulative-behavior-geriatric-patients/

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