Physicians are in the business of healing and dealing with people. Just as any business enterprise has difficult and demanding consumers, physicians also face their share of problem, or difficult, patients. The nature of challenges faced in the medical profession is unique and varied. Hence, physicians need to have a thorough understanding of patients and their problems. They also require knowledge about how to deal with challenging situations in their daily medical practice.
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Prevalence of Difficult Patients
- Hard to establish
- Dependent on type of practice
- Dependent on physician’s style
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The exact incidence of difficult patients is hard to establish since there are no standards by which to measure such patient behavior. It also may be related to the fact that physicians in general have no formal training in understanding or addressing such challenges placed on their practice by patients. In the business world, a separate department of customer service is established and staffed by people who are trained in dealing with demanding and challenging consumers. In fact, some of them use the input from their challenging consumers to vastly improve their services.
Hospital risk managers respond to “problem” patients. Similarly, professional liability insurance carriers have risk management seminars or guidelines regarding how to effectively handle patients. Physicians might learn from these resources and apply similar principles in their practices.
The prevalence of problems is dependent, in part, on type of practice and a physician’s style.
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Types of Difficult Behavior
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Demanding
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Non-compliant
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Drug-seeking
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Violent
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Complaining
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Angry
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Non-paying
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Needy
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Re-scheduler
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Seductive
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You know these patients: the one with a sheaf of Web printouts and a list of brand-name drugs who wants to argue over treatment; the brusque one who snarls at receptionists when appointments run late; the one who demands a second opinion as if you’re trying to cheat her out of an expensive treatment.
There are many terms used to identify a problem patient. At the most basic level, problem patients are defined by the feelings physicians have when they work with them. Frustration, uncertainty, anger and a feeling of being manipulated or controlled by the patient are common.
Most patients come to their physicians with specific medical problems—they are treated and leave the office. From time to time, however, non-medical related patient issues challenge a physician’s medical practice. Patients who present with behaviors such as those listed on the table may interfere with a physician’s ability to provide optimal medical care. A clear understanding of such issues and their implications can enable physicians to recognize and respond to patients. Such patients cannot be completely eliminated from a physician’s practice; however, a better understanding between the physician and patient may help resolve such issues.
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Why are Some Patients Difficult?
- They may feel mistreated, robbed or ignored
- Personality problems
- Social or financial problems
- Lack of trust, information or communication
- Cultural differences
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A substantial body of research has linked problem patient behaviors to numerous psychological and social factors. Some people have a closed perspective of their medical problems are not receptive to any suggestions offered by their physician.
For whatever reason, some patients may feel that they were mistreated by a physician, overcharged, or simply not heard by their physician. Certain personality characteristics may predispose patients to misunderstandings and poor communication. Social or financial problems may also cause patients to appear problematic or difficult.
Trust by a patient may not occur in the first physician-patient encounter. Communicating sufficient information in an effective manner to educate patients regarding their medical condition is the responsibility of the physician. This will facilitate a physician gaining the trust of their patients, with patients feeling confident that they were provided the necessary information about their particular condition.
Ethnic background and cultural beliefs can have a profound impact on patient behavior. It is up to the physician to be sensitive to these differences and take them into account during treatment.
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Last Published: 12/15/2005
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