Topic: Communication Skills: Dealing With Difficult Patients

Communicating with difficult patients is a challenge for all physicians. Doctors practice patient communication skills beginning as early as the first year of medical school with videotaped mock patient interviews and precipitator feedback to get it right.

The distrusting patient

Yet, there are some patient interactions that can leave even the most emotionally intelligent and well-coached physicians overwhelmed—and sometimes even frightened. It is important that doctors who take care of patients anticipate these types of inevitable interactions in advance and work towards solutions that promote peace of mind for everyone involved. The patient who says, “everybody lies. I know they are hiding something,” can make you feel like you just can’t do or say anything right. When a patient tells you that everyone is out to get them, it can be difficult to decipher whether the patient is inherently skeptical or whether they have been treated with dishonesty.

It helps to lean on teamwork in these situations. Feedback from other members of the healthcare team can help you sort out whether a patient truly was not given complete information at some point during their care or whether they are mistrusting of others without a solid reason.

The exception

As a solution, it helps to suggest resources to your patient—such as online access to their charts so that they can follow their own results. You can also make your medical notes and correspondence regarding their medical care available and accessible to them so that they can follow along and promptly double-check everything that you are doing. When you have a patient who insists that, “my body doesn’t work like everyone else’s,” or “don’t try the same things on me that you use with other people,” you may be in for a tough road.

Each person is unique. Patients’ health can certainly be complicated—computers can’t be programmed to safely take care of real patients because people are individuals and do not function like robots. But, it is a basic cornerstone of medical science that the human body tends to follow physiologic rules. When a patient is allergic to everything or has symptoms that don’t make sense, it can be hard to distinguish between a medically challenging case and a patient whose perceptions don’t match up to reality.

Acknowledging the uniqueness of your patient’s experience can provide them with validation. However, this validation has to be balanced with a reassurance that even exceptional people usually experience improvement with standard medical treatment.

Topic Discussed: Communication Skills: Dealing With Difficult Patients

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