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December 8, 2014

Medscape: How to handle 'difficult' patients

Daily Briefing

The best way to deal with difficult or agitated patients is to be upfront about the behavior considered acceptable in the doctor's office and apply those guidelines consistently, Mark Crane writes for Medscape Medical News.

Patricia Roy, a family physician in Muskegon, Michigan, says, "Any abusive behavior must be confronted immediately," including inappropriate or suggestive comments from patients to providers. Richard Roberts, a professor of family medicine at the University of Wisconsin Medical School, says, "I've said [to patients before], 'I know you're hurting, and I'll do my best to help you. But I can't have you talking to my nurses that way.'" He adds, "Sometimes the patient is unaware of his behavior until you have this conversation."

How do you hold difficult conversations with doctors?

Crane discusses three especially difficult situations providers sometimes encounter in the workplace and strategies for helping physicians have constructive conversations with patients in those situations.

Disagreements about treatment plans

Roy says that, when patients demand a certain medication or test, physicians must focus on three questions:

  • What is he or she looking to gain from this test/drug?
  • What will it change from the current regimen or treatment plan?
  • What are the risks associated with conducting the test or changing medication?


Creating a culture of prevention
Is your staff prepared to handle violent patients?

Gerald Hickson—SVP of quality, patient safety, and risk prevention at Vanderbilt University Medical Center—says physicians must "set the stage" and make it clear to patients that providers "make recommendations based on the exam history and best practices" and that you are considering "the whole gamut of possibilities" for their care. He says patients "need to understand [physicians'] thought processes or they'll be less likely to cooperate."

Joseph Scherger, VP at Eisenhower Medical Center in Rancho Mirage, California, notes that doctors "usually interrupt patients within 30 seconds of the start of their visit... [which] creates conflict and bad medicine." Instead, he suggests allowing the patient to tell their story so "you can learn what the patient is actually worried about." In turn, he says, the patient becomes "more receptive to hearing our recommendations."

Scherger also says physicians must clearly explain to patients why they believe a certain drug or test is not needed. However, if the patient insists on undergoing a medical test like an X-ray, agreeing to it as long as it isn't harmful to him or her is not always a bad idea.


Apologies can help

If a patient is forced to wait for an extended period of time past his or her appointment time, an apology from a physician can often diffuse tension and make the patient feel less disrespected.

"When the patient is angry, we apologize even when we're not at fault," says Patricia Roy. She adds, "Waited too long? Apologize. Hated the specialist I referred them to? Apologize. Not happy with the outcome of a test, treatment, etc.? Apologize." She explains, "Patients are forgiving if you are seen as genuinely sorry for what happened to them, regardless of how it happened."

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But Roy says it is just as important to address the problem as it is to apologize for it.

Make an extra effort to hear the concerns of pushy patients

When patients push providers' buttons, it is important that the physicians go the extra mile to express concern and understanding, even if they are irritating or ill-behaved. Roberts says, "To better understand the patient's agenda, pay attention to his demeanor. Don't rush to judgment," adding, "The patient deserves the benefit of the doubt."

If patients begin the appointment with a list of complaints, the physician should work to guide him or her to address the most prominent concerns without being dismissive.

In addition, difficult patients can often be the result of overstressed physicians, so it is important to be aware of your own attitude. Hickson says, "Physicians, like anyone else, have attitudes that can discriminate and hold patients in a poor light," and that they should be mindful of responding to their own stress in a professional manner and not taking it out on the patient (Crane, Medscape Medical News, 12/4).

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More from today's Daily Briefing
  1. Current ArticleMedscape: How to handle 'difficult' patients

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