Difficult Patient Situations

Difficulties sometime arise during patients' visits that are not anticipated. For example, a patient may be feeling so poorly that without realizing it, cooperation is difficult. It is the physician's task to make the patient feel at ease and as comfortable as possible. In other cases the staff may not have fully prepared the patient for the physician. It is the physician's demeanor that sustains the interview with a sense of ease as the difficulty is addressed or the omitted information attained.

Sometimes, the patient is difficult from the very beginning because of the illness, personality, or the process of moving through the office system. Already under the stress of not feeling well, the negative attitude of the difficult patient is only exacerbated by the many small issues that may arise in the interview. Some patients are irritated about having to wait; having no clear diagnosis; or being denied their request for an antibiotic to treat a viral infection.

Psychiatrist Beryl Lawn (2004) says that the difficult patient is most often afraid; it is this deep fear that something is wrong that the patient cannot control. The personality of the difficult patient may lack the flexibility or resilience that is necessary for coping with other people and with day-today living. In the stress of the medical environment, difficult patients may become angry and try to take control of the process as a way of controlling their inner fears of inadequacy.

Sometimes, stepping back or to the side provides the upset patient with some personal space to regain composure. The physician then continues the interview, without trying to analyze or explain the difficult behavior. It is the work of reconnecting with the patient, of maintaining respect and working to establish rapport and relationship.

Another difficulty is the patient's ambivalence, such as hesitancy in making a medical decision or a lifestyle change decision. The physician may offer a respectful response such as, "I cannot decide for you. However, I do believe that it is an important decision, and I will respect whatever you decide." In this way, the physician assures the patient that medical treatment will be continued, regardless of how the ambivalence is managed. Some people are paralyzed by ambivalence, and they may remain at this point of indecision for some time. Some people do nothing until some externally imposed deadline, such as a job application drug screening, makes the decision for them (Ubel, 2002).

Whatever the difficulty, the physician maintains rapport, respect, and relationship with these difficult patients by listening for their concerns. By giving the impression of being unhurried and having time to listen, the physician maintains relationship and conveys to the patient that the physician-patient relationship will continue, undamaged by the present difficulty. In this way the relationship becomes a part of the healing process.

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