Handling Difficult Patients

Sherry Krueger
October 12, 2012 — 1,353 views  
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We all have them, but no one wants them--difficult patients.  I'm not talking about patients with complex medical conditions.  I'm talking about patients who try your patience. The occurrence is so frequent that Seinfeld had an episode devoted to the problem, though for the doctor and the real patient it is not so humorous.  For over 30 years researchers have found that doctors have consistently described about 15-20% of their patients as ‘difficult'.  More detailed surveys have found that doctors who are younger and female tend to have more ‘difficult' patients in their practice.

To keep these patients from becoming a drain on your practice, both emotionally and time-wise you should learn to spot the difficult patient early in your treatment program. This will minimize your time involvement; yet allow you to meet their healthcare needs.

The most common behaviors of difficult patients include the following:

• Insist on being prescribed an unnecessary drug.

• Show dissatisfaction with care.

• Have unrealistic expectations for care.

• Visit regularly but ignore medical advice.

• Complain persistently, although the doctor has done everything possible to help.

• Insist on an unnecessary test.

• Are verbally abusive.

• Do not express appropriate respect.

The above behaviors are typical of many different types of ‘difficult' patients, which can generally be classified into four basic groups.  These classifications come from researchers David B. Arciniegas, MD, and Thomas P. Beresford, MD.

  1. Dependent clingers. Early in the medical relationship, these are the patients who pour on the praise. They've finally found a doctor who can help them! They flatter their physicians into providing special privileges, such as access by personal phone, email or permission for after-hours communications. But soon, the patient's over-the-top gratitude becomes replaced by ever-increasing demands.

  2. The entitled demander. This type of patient likes to tell you what types of tests to order and medications to prescribe--and may threaten legal action if denied.

  3.  The manipulative help-rejecting complainer. This type of patient drags physicians through endless cycles of help-seeking and help-rejecting. Nothing the doctor does is ever satisfactory, though they keep coming back with new requests.

  4. The self-destructive denier. This is the patient that knowingly continues behaviors that are dangerous to their health--drinking with a bad liver, smoking after being diagnosed with lung disease and other infuriating methods of apparent "suicide by treatment nonadherence."

The one trait that all of these types of difficult patients have in common is that they are all begging for attention.  These patients are lacking the attention they crave at home, at work, or socially.  They not only need physical healthcare, they often need mental healthcare, too.  If you, or a trusted colleague, can meet the emotional need that these patients crave, then they will often become long term, satisfied patients who can be a tremendous referral source.  Often, if you can establish an atmosphere of ‘we're in this together and we need to work together to solve your healthcare needs' the difficult patient will become a success that you can feel good about because you have helped a person that others have tried to help and failed.

While it is easy to dismiss the complaints of a ‘difficult' patient, remember that the patient may have a legitimate health problem.  It is too easy to dismiss any new or different complaint that the ‘difficult' patient has as another cry for attention.  Do not fall into this trap, even if you are ‘sure' that the patient is fabricating the symptoms.  It just takes one patient where you miss a proper diagnosis and the patient develops a serious condition to destroy a practice.  Many ‘difficult' patients are also the most likely of all patients to initiate a malpractice suit.

And finally, as to why female and younger doctors tend to have more ‘difficult' patients in their practice can be readily explained.  Female healthcare providers are more likely to meet a patient's emotional needs or have more patience with the patient's underlying emotional problem.  And guys like me are more than willing to help out the ‘new' doctor down the street by referring our ‘difficult' patients to the young practitioner to help him build his practice.  Actually this might be win-win-win situation because I get rid of a problem patient, the young doctor gets more patients, and the patient may get treated by a doctor with more time to spend on their case.


Sherry Krueger