Difficult, demanding and angry patients Flashcards
Fact
‘It is the patients who have the problems while doctors have the difficulties.’
the more common types of difficult ‘heartsink’ patients are:
dependent clingers
entitled demanders
manipulative help rejectors
self-destructive deniers.
Management
Adhere to the principles of good communication and consulting skills, esp.
- the art of listening
- rapport building
- diplomatic confrontation
- facilitation and searching.
Seek the reason for the behaviour
become familiar with the characteristics of personality disorders, esp. the antisocial (sociopathic) group e.g:
- impulsive ‘mad dog’
- borderline ‘hell raiser’
- narcissistic ‘prima-donna’
Guidelines for handling the angry patient, Do:
listen
be calm and comfortable
be conciliatory and genuine
show interest and concern
be sincere
give time
allay any guilt
arrange follow-up
be a friend in need.
Guidelines for handling the angry patient, Don’t:
meet anger with anger
touch the patient
reject the patient
be evasive or a ‘wimp’
be overfamiliar
judgmental or patronising
talk too much.
Five step approach for drug-dependent ‘shopper’
- Elicit request for drug early:
* ‘what did you have in mind?’ - Respectful refusal and brief minimal explanation:
- I don’t prescribe x
- I could but I choose not to
- Avoid being drawn into the patient’s agenda
- Depersonalise:
* ‘It’s not you personally—it’s the way I work.’ - Offer alternative help
The Discomfort Zone:
A Guide to Managing Difficult Consultations
