Professionalism & Difficult Patients

Dealing with difficult or uncooperative patients is an unenviable part of a medical professional's job, yet vital to working successfully within the field. However, showing empathy is only half the battle. When a patient's emotional reactions exceed the ability to cope with them, the physician must learn how to get directives across, without coming across as too authoritarian. Mastering this skill will develop the professionalism needed to help both sides.

Identification

• Overcoming the natural tendency to ask questions is the first key step in dealing with difficult patients. Many patients are already stressed out from confronting several mental and physical issues, which can complicate good medical care. Telling a worried patient, "You seem quite upset about your condition"--instead of asking why they feel that way--can deepen rapport, and build the trust needed to determine what is wrong.

Function

• Many patients are fearful of what may happen to them.

  Voicing empathy through simple statements, rather than questions, is not enough. Physicians must build on the rapport they have developed by using legitimating statements, or expressions that show an understanding of the situation from the patient's viewpoint. Statements like, "I would be upset in your position," help break to down a patient's defenses, and lay the groundwork for advice they might not accept otherwise.

Anxious Patients

• Anxiety is a major driver of negative emotions in difficult patients.

  Understanding the psychology behind difficult patients' thought processes is crucial to addressing their behavior. Difficult patients were often manipulated as children, leading them to suspect they will get the worst of every deal. In these situations, overexplaining what's happening next is the effective response. In other cases, doctor or hospital phobias may come into play for patients who have faced down severe traumas. Reassuring patients that they will not lose control, money or time will ease their fears.

Warning

• Getting angry with difficult patients is not recommended, because it may affect a physician's judgment, says Dr. Michael F. Lubin--author of the "Ten Commandments for dealing with difficult patients." Liability is a concern, as well, because physicians can always be sued, whether they acted properly, or not, Lubin stresses. However, physicians should not accept foul language or aggressive behavior, either. If these issues persist, the physician can ask the patient to leave, or forgo treatment.

Considerations

• Recognizing when patients are dealing with mental health problems--ranging from severe depression, to psychosis and schizophrenia--holds important implications for doctor-patient relationships, as well. The physician needs to know when patients are in touch with reality, and genuinely able to take medication, follow directives or perform treatments on their own. Holding firm on behavioral standards is not similar to accepting substandard care, nor allowing patients to leave on such a note.