There are definitely some difficult people in this world. They’re the people who are difficult on any given day for anyone who interacts with them. Then there are the “normal” people” who are difficult to deal with in specific circumstances. Doctors meet members of both camps on a regular basis. In fact, a recent study concluded that participants identified 1 in 6 patients as being “difficult”.
Think of those patients who present with endless lists of symptoms. Then there are some who can’t stop talking about stuff that’s unrelated to their reason for visiting you. Others are demanding or angry. Some think they know it all or just won’t listen to what you have to say. Some patients are unable to articulate what you need to hear from them. Then there are the patients who don’t want to share information with you! I’m sure you can add your own additional categories to this list.
The patient’s experience?
Maybe the fact that there are so many difficult patients is unsurprising when we consider the situation from their perspective. Factors such as physical pain, nausea and anxiety can affect anyone’s behaviour. Sometimes, it helps to pause and take things to extremes. What happens when you unexpectedly catch your finger in a drawer? Stub your toe? Or bang your head on a shelf? Your ability to hold coherent conversation is typically displaced by a full-body muscle reaction, a sudden deep inhalation followed paralysis of breathing, all accompanied by loud yelp – and perhaps an unrestrained string of expletives!
Something similar happens with any shock to our system, whether that be physical or emotional. In addition, low key, persistent nagging symptoms are typically accompanied by low key, persistent, nagging reactions. All of this impact on behaviour. How many of your patients fall into that category?
It’s interesting to note that the patients who were identified by their doctor as being difficult were less satisfied with their visit. The outcomes fell short of their expectations.
The doctor’s experience?
Of course, doctors are not immune to factors impacting behaviour. Tiredness, hunger and excessive workload are pressures that are all too common. Difficulties with team dynamics can add to these stresses and strains. Then there may be external personal matters that come into play. It’s just too easy to say that such matters should stay external and not affect you in your work – but we are all human. So, we all have some days when we are better than others. And there are some days where we struggle.
It’s important to bear in mind though that the rate of 17% of patients identified as difficult is the average figure from the study mentioned. What constitutes “difficult” is a perception which varies from one doctor to another. True, some may have a relatively easier patient demographic than others. But there are also individual variations due to levels of experience, abilities and general outlook.
One conclusion from the study is that Resident Doctors were more likely to identify a patient as being difficult than their more senior colleagues. In addition, a higher percentage of patients perceived as “difficult” by a doctors is directly related to lower job satisfaction and risk of burnout.
The way forward?
Your average patients don’t go on courses to learn how to communicate with doctors. They may well have no idea how to go about interacting with you. When they visit you, they could be having an experience which is unknown territory for them or frustrated in some way. All the complicating factors already mentioned come into play. Yes, their behaviour plays a key role in whether or not you can achieve the ideal of you working together in concordance. But do they even know what that means? Do they know that’s what you want to achieve? (Assuming that actually is what you want to achieve).
Your training means you are far more likely to have technical knowledge of their condition, assessment methods and treatment option. But that doesn’t mean you know it all. Your patient may well have valuable insight into what has changed with their body, the impact this is having upon them and what they want. Your challenge is to meet them where they are and make progress together from there.
Thankfully, although you may not be able to choose your patients, you can choose how to develop and maintain your own communication abilities. Enhancing your clinical knowledge, gaining experience and improving your communication skills are all essential tactics in reducing the number of difficult patients. The results are improved outcomes and an increase in your job satisfaction.
What steps are you taking to reduce the number of difficult patients you see?
Stephen McGuire- Managing Director
