Regarding the ‘difficult patient’

Rethinking the difficult patient encounter.

Laura is a 49-year-old woman with posttraumatic stress disorder and chronic headaches who takes 200 mg of morphine twice daily and is in an electric wheelchair for no clear reason. Peter is a 53-year-old, morbidly obese man with poorly controlled Type 2 diabetes mellitus. Despite multiple visits focusing on lifestyle changes and medication adjustments, his A1C remains wildly uncontrolled and hi...

Management of the difficult patient.

All physicians must care for some patients who are perceived as difficult because of behavioral or emotional aspects that affect their care. Difficulties may be traced to patient, physician, or health care system factors. Patient factors include psychiatric disorders, personality disorders, and subclinical behavior traits. Physician factors include overwork, poor communication skills, low level...

The Challenge of the Difficult Patient

It is common for mental health professionals to label a patient as “difficult”; however, it remains unclear as to what the classification actually means or what it entails. Koekkoek and colleagues reviewed 94 articles published between 1979 and 2004 in order to answer 3 questions: (1) “What are the defining characteristics of difficult patients?” (2) “How is the difficulty explained?” and (3) “...

Field guide to the difficult patient interview

Repairing "Difficult" Patient-Clinician Relationships.

Using a case example, we offer guidance for improving "difficult" clinician-patient relationships. These relationships may be repaired by acknowledging a clinician's part in conflict, empathizing with patients, identifying a patient's skill deficits, and employing communication and engagement techniques used by mental health professionals. Clinicians will inevitably take on more of the work of ...