Handling Difficult Patients

We all have them, but no one wants them--difficult patients.  I'm not talking about patients with complex medical conditions.  I'm talking about patients who try your patience. The occurrence is so frequent that Seinfeld had an episode devoted to the problem, though for the doctor and the real patient it is not so humorous.  For over 30 years researchers have found that doctors have consistently described about 15-20% of their patients as ‘difficult'.  More detailed surveys have found that doctors who are younger and female tend to have more ‘difficult' patients in their practice.

To keep these patients from becoming a drain on your practice, both emotionally and time-wise you should learn to spot the difficult patient early in your treatment program. This will minimize your time involvement; yet allow you to meet their healthcare needs.

 

The most common behaviors of difficult patients include the following:

 

• Insist on being prescribed an unnecessary drug.

• Show dissatisfaction with care.

• Have unrealistic expectations for care.

• Visit regularly but ignore medical advice.

• Complain persistently, although the doctor has done everything possible to help.

• Insist on an unnecessary test.

• Are verbally abusive.

• Do not express appropriate respect.

 

The above behaviors are typical of many different types of ‘difficult' patients, which can generally be classified into four basic groups.  These classifications come from researchers David B. Arciniegas, MD, and Thomas P. Beresford, MD.

 

1. Dependent clingers. Early in the medical relationship, these are the patients who pour on the praise. They've finally found a doctor who can help them! They flatter their physicians into providing special privileges, such as access by personal phone, email or permission for after-hours communications. But soon, the patient's over-the-top gratitude becomes replaced by ever-increasing demands.
   
   
2. The entitled demander. This type of patient likes to tell you what types of tests to order and medications to prescribe--and may threaten legal action if denied.
   
   
3.  The manipulative help-rejecting complainer. This type of patient drags physicians through endless cycles of help-seeking and help-rejecting. Nothing the doctor does is ever satisfactory, though they keep coming back with new requests.
   
   
4. The self-destructive denier. This is the patient that knowingly continues behaviors that are dangerous to their health--drinking with a bad liver, smoking after being diagnosed with lung disease and other infuriating methods of apparent "suicide by treatment nonadherence."

 

The one trait that all of these types of difficult patients have in common is that they are all begging for attention.  These patients are lacking the attention they crave at home, at work, or socially.  They not only need physical healthcare, they often need mental healthcare, too.  If you, or a trusted colleague, can meet the emotional need that these patients crave, then they will often become long term, satisfied patients who can be a tremendous referral source.  Often, if you can establish an atmosphere of ‘we're in this together and we need to work together to solve your healthcare needs' the difficult patient will become a success that you can feel good about because you have helped a person that others have tried to help and failed.

 

While it is easy to dismiss the complaints of a ‘difficult' patient, remember that the patient may have a legitimate health problem.  It is too easy to dismiss any new or different complaint that the ‘difficult' patient has as another cry for attention.  Do not fall into this trap, even if you are ‘sure' that the patient is fabricating the symptoms.  It just takes one patient where you miss a proper diagnosis and the patient develops a serious condition to destroy a practice.  Many ‘difficult' patients are also the most likely of all patients to initiate a malpractice suit.

 

And finally, as to why female and younger doctors tend to have more ‘difficult' patients in their practice can be readily explained.  Female healthcare providers are more likely to meet a patient's emotional needs or have more patience with the patient's underlying emotional problem.  And guys like me are more than willing to help out the ‘new' doctor down the street by referring our ‘difficult' patients to the young practitioner to help him build his practice.  Actually this might be win-win-win situation because I get rid of a problem patient, the young doctor gets more patients, and the patient may get treated by a doctor with more time to spend on their case.

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About the Author

Welcome to our PhysicianTrends Blog.  We're here to talk about physicians and how they are changing in the midst of the most massive transformation in our healthcare system since Medicare. To find out more please visit http://www.physiciantrends.com

Family Doctors: Finding the Right One For Your Family

Every family needs a good doctor, but it can also be difficult to find one. Most doctors have an established base of patients and it can be difficult to find one with space to take new patients. It's also a challenge to find a Canadian GP that you are comfortable with.



A family physician is able to treat the entire family, from parents to kids. However, not every doctor is suited to this. Some still have old fashioned ideals about women or aren't good with kids. Sometimes it can take a bit to search out the right person for your family.



How do you go about finding the best family GP? Word of mouth is a great way to get someone trustworthy. When someone else recommends a doctor, it is very probable that they are doing so because they are happy with the results and with the physician's bedside manner. Getting someone to recommend a doc to you doesn't guarantee that he or she is right for your family, but it is a very good start.



There are a few things to look for in a doctor. First of all, it's best to encounter someone who is equally good with adults and children, even if there aren't any in the family yet. This ensures that the family can grow and not have to change GPs. Not all GPs are good with kids, so take the time to do some research.



A great doctor will also have space in his or her schedule to admit new patients. This is becoming increasingly harder for practitioners as there are so many patients. Most people don't like to wait several weeks or months for an appointment, so it's best to look for someone who can set up appointments within two to three weeks. Emergencies should be accommodated, as well.



One thing that can help with the frequent unavailability of a physician is to look into a clinic setting where several practitioners work and patients are moved between them, according to who is available on any given day. While this offers less chance to get to know just one person, it does ensure that there will always be someone attending. It might be a good idea to meet everyone who works at the clinic first and check out their credentials to see if the clinic is a good fit for your family.



Some people prefer to see a younger doctor, knowing that it is less likely he or she will retire anytime soon. That's not a guarantee though and many people are quite the opposite, preferring an older, more experienced GP. The choice depends on personal preference in the end.



Finding great doctors isn't always easy. Once the perfect one is found, however, it's worth it. Having someone the entire family can see, who is personable and knowledgeable and who is able to see patients relatively quickly, is invaluable. It is worth the time it takes to find the best person to see, since hopefully it will be a very long term relationship.

About the Author

When an individual is ill and in need of a remedy they should go and consult a physician. There are many different types of doctors or specialists who each focus in a specific field of medical practice such as paediatrics, or family practice.