Awareness and understanding for "difficult" patients

Ethics Forum. Aug. 4, 2003.

How do you manage challenging clinical encounters?

What do you do when you see in your appointment book the name of a patient with whom you have a difficult relationship? How do you handle the fact that visits with this patient are not satisfying, that the patient frustrates your desire to solve medical problems and help people?

Reply:

Health care professionals in every discipline encounter so-called "difficult patients."

Such patients present in various guises. Some are angry. Some are needy and become difficult when the physician tries to end the exam or interview. Some are abusive and demanding. Some patients are "noncompliant," while others are engaged in behaviors we label "self-destructive."

While less is written on the subject, I include under the discussion of "difficult patients" those subtle manifestations of patient-professional encounters that have more to do with vulnerabilities and experiences in the life of the health professional than anything intrinsically difficult about the patient.

Examples are plentiful: the oncologist who recently has lost a loved one to cancer and now must return to his clinic; the pediatrician who has a child with a learning disability and struggles with children who have similar problems; the psychiatrist who has a sister with schizophrenia and finds extremely psychotic patients challenging; the family physician who is intolerant of alcohol abuse because of a personal experience with an alcoholic mother; and many others.