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Whenever and wherever health professionals congregate, it does not take long for them to bring up the topic of difficult patients. Patients and families we experience as difficult often increase the frustration and decrease our satisfaction with work. They make it difficult to deliver the person-centered care that is at the heart of high-quality, satisfying, and effective health care. Why, we ask, would someone come to the office, emergency department, or hospital and harass, abuse, demean, or lie to us?

Fortunately, most difficult interactions are both diagnosable and repairable. Apart from the rare patient who seems determined to be difficult, most problematic situations are created by unsatisfactory communication between practitioners and patients or by personal issues the practitioner or patient unknowingly bring into the visit. Such issues can mirror similar problems within the practitioner’s own world and provoke negative reactions to an inherent or overt aspect of the patient’s physical condition, sexual orientation, personality, or lifestyle.

At times, practitioners consider patients difficult based on their similarity to family members or others with whom they have had a close relationship or interpersonal problems. For example, a physician whose uncle used anger to control her may now have problems with an older male patient who responds angrily when she refuses to prescribe an antibiotic for an upper respiratory infection. Another common situation is the practitioner who is unusually intolerant of patients who will not stop smoking. This practitioner may well have had a close relative whom he or she could not convince to stop smoking, who later died from lung cancer. Developing the self-awareness to separate one’s own past experiences and relationships from the current clinical interaction can significantly moderate one’s aversive response and reduce difficult interactions. The key to dealing with such situations is to carefully examine how visits are progressing while monitoring one’s own responses to the patient and the interaction. Greater self-awareness about their own feelings, experiences, and beliefs can help practitioners approach the clinical interaction with more self-reflection and less judgment and frustration. The case illustrations that follow focus on some of the more common challenging patients and situations that practitioners will encounter, and offer specific approaches to dealing with them. Table 4-1 summarizes some general guidelines for working with difficult patients. Table 4-2 recommends practical strategies for approaching specific situations.

Table 4-1.General guidelines for working with difficult patients.
Table 4-2.Tips for approaching difficult situations or patient behaviors.

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