Difficult patients.
We’ve all encountered them.
Maybe we are them. (After all, they say doctors make the worst patients, and there’s probably some truth to that.)
But what makes a patient “difficult”?
Is it someone with multiple complex medical issues or a condition you haven’t been able to diagnose or don’t fully understand?
Is it someone with many questions, especially right at the end of their visit?
Is it someone who doesn’t follow your treatment plan or any of your advice?
Is it someone with a psychological overlay to their symptoms or exam findings?
Is it someone with a language barrier, one who moves slowly, one who brings multiple people with them, or has any other cause to lengthen the visit?
Is it someone who complains a lot or expresses dissatisfaction with their care?
Is it someone who shows up late?
What do you consider a difficult patient?
We may each have a different definition of what constitutes a “difficult” patient, but we can all agree on one thing: we don’t look forward to seeing these patients and would prefer to avoid it if we could.
It’s human nature to move away from what is unpleasant or uncomfortable.
The problem is that sometimes following your human nature does not lead you to the best results. In fact, in this case, human nature is likely doing you (and your patients) a disservice.
There are at least two problems when it comes to believing your patient is difficult:
What you believe about your patient is what you end up becoming. The less often you see difficult patients, the more difficult they become.
How you end up becoming the exact thing you dislike.
When you believe your patient is “difficult,” you end up feeling several not-so-pleasant emotions.
You may feel resistance, dread, frustration, anxiety, annoyance, overwhelm, and exhaustion, to name a few. You then take action from these negative emotions.
You may do things like avoid calls or questions and give curt or brief replies. You may let messages from this patient linger in your inbox longer than others or take longer to close their chart. You may try to emotionally and physically distance yourself, however subconsciously. You may get stuck in your head thinking about all the annoying, rude, disrespectful things your patient has done in the past. You build up a case for how difficult they are, finding lots of evidence to support your story, all the while keeping you from doing other work or interfering with your personal time. You may request less frequent follow-up visits so as not to have to deal with all of this again too soon.
What you’ve now done is become difficult yourself, making your life more challenging and potentially compromising the patient’s care. Your visits, when they do happen, take longer than necessary or, at the other extreme, may be too short, which can cause you to miss important information. You are more likely to get more calls and questions outside of the actual visit, which requires more time. And you are more likely to experience mental fatigue, exhaustion, and even burnout.
Your belief that this patient is difficult leads you to take actions that create a more challenging scenario for both of you.
The more often you see your difficult patients, the less complicated they become.
Contrary to what human nature wants you to do, I have found that the MORE often you see your “difficult” patients, the less complicated they become.
The more you see the tough, challenging, emotionally “needy,” question-asking, positive review of systems patients, the more you get to understand them and build up trust.
Like with any relationship, trust is the bedrock where the physician-patient (or nurse or mid-level or therapist, etc.) relationship can thrive.
Without trust, you have nothing.
The more you see someone, get to know them, and understand their fears and idiosyncrasies, the better you can pick up real concerns and findings and distinguish them from the less concerning ones.
The more you understand them, the better able you are to anticipate challenges and plan ahead for them. For example, you can request a visit at the end of the day or before lunch when you will have more time to answer questions for the patient you know will ask several at the end of the visit. Or you can request your slower patient comes in earlier than normal and change before they are seen if you anticipate a physical exam will be needed.
A patient who knows you are willing to see them and see them often won’t feel like they need to hold all of their questions for the one chance they get to see you. They won’t feel like you’re abandoning them. You can address different issues at different visits and tell them the plan to do that.
The more the patient trusts you, the more likely they are to adhere to your recommendations and the more likely they are to have a better outcome. The more likely YOU are to have a satisfied patient and a more satisfying patient encounter.
What to do instead.
If you currently believe you have difficult patients or have ever had this thought, there’s absolutely nothing wrong with you. We’ve all been there.
You just want to become aware of these beliefs and realize that they have potential negative consequences for both you and your patients.
The good news is that your beliefs are totally optional. They are not set in stone, and you always have the ability at any given time to question your beliefs and change them.
You may go through this exercise and discover the result that your belief is creating and find that you don’t like what you see. Now you get to decide to let go of this belief and adopt a new one that is just as true but leads you and your patient to a better result.
For example, your new belief may be, “This patient is feeling really scared and vulnerable.” Or, “This patient needs extra reassurance because they had a negative medical experience in the past.” This new thought will help you take actions before, during, and after the visit that will save you time and energy and give the patients a better outcome.
Sofia Dobrin is a neurologist and physician life coach.
