Challenging interactions

Question 1

What factors contribute to a challenging interaction?

Answer 1

 Staff e.g. HALT (Hungry, Angry, Late,
Tired)
 Patients
 Disease i.e complexity, treatability
 Environment/System i.e staffing, economic

Question 2

What can cause prolonged difficult interactions?

Answer 2

 Unresolved or repeated complaints
 Patients who are never satisfied
 Medically unexplained symptoms

Question 3

Why are these difficult patients challenging?

Answer 3

 Takes up time/resources
 Emotionally draining
 Contributes to stress/anxiety in clinicians
 Affects healthcare decisions
 Make mistakes/complaints
 Encourages changing services e.g. doctor
shopping
 Safety e.g. verbal/physical assault

Question 4

What are the common consequences of difficult patients?

Answer 4

 Passion: ‘missionary-like zeal’
 Resignation: ‘nothing I can do’
 Acceptance: ‘just give he/she what they
want’
 Ignoring: ‘what problem?’
 Refusal: ‘I won’t see difficult patients’

BUT also
 Can lead to useful insights/reflections
 Knowing your limits/boundaries
 May bring the team together e.g. shared
purpose
 Quality improvement

Question 5

What is transference?

Answer 5

-Unconsciously transfer
feelings & attitudes from person or situation from past on to person or situation in the present

E.g. patient afraid that he/she seriously ill
& may adopt helpless child-like role and
project omnipotent parent-like quality to
the clinician  expected to provide a
solution

Question 6

What is counter transference?

Answer 6

• Response that is
  elicited in the therapist by the patient’s
  unconscious transference
  communications

i.e Feelings and thoughts, Conscious

Question 7

How can you deal with the distressed patient?

Answer 7

• Empathy
• Attentive silence
• Time and space if crying.
• let them volunteer info

Question 8

How do you deal with the talkative patient?

Answer 8

• Redirect and state why - because it is important
• Put boundaries in place i.e I have ten minutes before the next appt.

Question 9

How do you deal with the angry patient?

Answer 9

• Acknowledge
• Validate
• Explore
• Safety (can use other colleagues)

Question 10

How do you deal with boundary invasion?

Answer 10

• Be alert for if it happens
• Stand firm and easy
• Dont use personal reasons
• Take action fi required

Question 11

How do you deal with difficult patients?

Answer 11

• Follow their story
• See it from their perspective
• Attentive silence

General:
Stay calm
 Focus on patient care
 Focus on the person in front of you
 Don’t take it personally
 Don’t accept abuse
 Show that you care
 Think about your safety

Question 12

What do you do after a difficult patient?

Answer 12

• Summarise after the history of the
  presenting complaint
• Debrief session with colleagues/peers
• Document key information

Question 13

Whats the BATHE technique for tricky pt?

Answer 13

 B= Background
What is going on in your life?
 A= Affect
What do you feel about that?
 T= Trouble
What about this situation troubles you the most?
 H= Handling
How are you handling this?
 E= Empathy
That must be very difficult for you

Question 14

Whats the super relevant rebels technique for a tricky patient?

Answer 14

 Recognise the problem
 Express Empathy
 Establish clear Boundaries
 Emphasise the patient’s best interest
 Use inclusive Language
 Focus on Solutions