WHO IS THE DIFFICULT PATIENT?

One who impedes the clinician's ability to establish a therapeutic relationship A person who does not assume the patient role expected by the healthcare professional, who may have beliefs and values or other personal characteristics that differ from those of the characteristics that differ from those of the care-giver, and who causes the caregiver to experience self-doubt"

THE HOW TO OF DOCTOR-PATIENT

COMMUNICATION All communication problems are relationship problems. When communication is difficult, the physician should reflect on his/her possible contributions to the difficulties. Talking about fears, worries, & the impact of the illness on the patients life is always therapeutic.

WHO IS THE DIFFICULT PATIENT?

Typical Difficult Patients: Angry patients Patients in pain Anxiouspatients

UNDERSTANDING AN ANGRY PATIENT

Mostly due to: Unmet expectations Having a disease (suffering the consequences) Long waiting time (Perceived) unfair treatment Inefficient / unfriendly / unresponsive staff Wrong diagnosis / treatment Missed diagnosis

THE SKILLS
All the ones you learned previously AND 1. Interpersonal space 2. Reflection (statement of an observation of a feeling or verbal response) 3. Facilitation (any comment or behaviour that encourages elaboration) 4. Personal support

WHAT YOU SHOULD DO

Reflect You look a little upset.

Pause and be attentive (facilitate)

Tell me about whats upsetting you.

Acknowledge the difficulty

Having to wait for 2 hours is really a long time. Please accept my apologies.
Tell me more about what the receptionist said to you. Its very frustrating to wait for so long.

Find out the specifics

Express empathy

Guess the meaning behind the anger

Was it frustrating because you felt it was a waste of your time?

Take an action on patients behalf

Ill find out what caused the delay. Maybe it is something that can be avoided the next time.
Would you like to register a complaint?

Link the patient with resources

Transition to purpose of visit

Well, now that you finally got to see me, what can I do for you today?

UNDERSTANDING A PATIENT IN PAIN

Mostly due to: Immediate pain symptoms Reduced mobility Increased dependence Worry about condition Expects immediate relief

WHAT YOU SHOULD DO

Observation Verbalizes specific expressions

Observe with your eyes, ears, nose, hands

Showing some form of concern

I can see that you are in pain

It must be difficult for you to ..

WHAT YOU SHOULD DO (CONT.)

Explaining the need for cooperation The information is important for us to understand your condition.

Encouraging & reinforcing positive change

How are you feeling now? Can we continue?

Establishing & maintaining control of the situation

I understand the: pain you are going through the difficulties you have faced but

IDEALDOCTOR-PATIENT RELATIONSHIP

What is Partnership? Partnership implies a team approach , in which patient & doctor work together toward the same goal. The use of the pronouns We&Usexpresses partnership.

EXAMPLE

Lets work togetherin looking at this problem Lets figure out a way (together) to help you with this problem Perhaps we canwork together to make you feel better Together we canwork out some solutions that may help after wehave talked some more about your problems

UNDERSTANDING AN ANXIOUS PATIENT

Mostly due to: Medical conditions Worry about self or family members Missed / lost opportunities Misunderstanding / myths / hearsay Stigma Family history Fear

EXPLORATION
The primary communicative intervention for patients with anxiety is to explore concerns & fears. "When you think about your illness, what are you most afraid of?" Yes, we hear about cancer everydayCan you tell me what makes you think it could be cancer?

SOME TIPS

Listen. Anxious patients are usually eager to tell their stories. Make eye contact. Give them enough time. Ask open-ended questions. Express genuine concern for their suffering and offer hope that they will feel better. Make it clear that you take their complaints seriously.

SOME TIPS(CONT.)
Summarize what you believe you have heard and invite your patient to clarify your perceptions. Ask them whether there are any other important things they want you they want you to know, and whether they to know, and whether they believe you have a good understanding of their case.

HOW TO COMMUNICATE EMPATHY

Verbal (other than I understand) I really feel bad for you. That must be very difficult for you to cope with. You seem (sad / angry / stressed) today. This cant be an easy time for you. Well work together to get through this. Please call me anytime.(If you say this, be sure that you can make yourself available).

HOW TO COMMUNICATE EMPATHY

Non-Verbal Using a sad or sympathetic tone of voice Expressing concern through your facial expression Touching a patients hand / pat on the shoulder

TAKE HOME MESSAGE

All of your knowledge about dealing with difficult patients will be of no value unless you master a clinical approach that allows for a caring attitude, a thoughtful evaluation, and an accurate diagnosis and appropriate treatment.