Difficult Pts Flashcards
1
Q
What are most problematic situations caused by?
A
- unsatisfactory communication between providers & patients
2. personal issues the provider or patient unknowingly brings into the visit.
2
Q
true false:
Most difficult interactions are both diagnosable and repairable.
A
True
3
Q
How can providers approach clinical interactions with self-reflection and less judgment and frustration?
A
- Develop the self-awareness to separate one’s own past experiences and relationships from the current clinical interaction.
- Carefully examine how visits are progressing while monitoring one’s own responses to the patient and the interaction.
4
Q
What are the general guidelines for working with difficult pts?
A
- Seek broader possibilities for the patient’s emotion or problems
- Respond directly to the patient’s emotions
- Solicit the patient’s perspective on why there is a problem
- Avoid being defensive
- Seek to discover a common goal for the visit
5
Q
What are the non-verbal indications of an angry pt?
A
- Rigid posturing
- Piercing stare
- Refusal to shake hands
- Gritting teeth
6
Q
What are the verbal indications of an angry pt?
A
- Very confrontational
2. Occasionally abusive language
7
Q
What are the subtle behaviors of an angry pt?
A
- Refusing to answer questions
- Failing to make eye contact
- Crossed arms
- Turning away from provider
- Increase physical distance
8
Q
What are potential causes of an angry pt?
A
- Anger towards provider
- Difficulty in getting to the office
- Problems with the office staff
- Anger toward the illness from which the person suffers
- Anger at the cost of health care
- Problems with consultants to whom the provider referred the patient
- Unanticipated problems from a procedure or medication recommended by the provider
- Previous unsupportive or condescending treatment by a physician
- Absent or miscommunication between members of the healthcare team
- Other significant news or problems unrelated to medical service, such as work-or family-related conflicts
9
Q
What is the provider response to an angry pt?
A
- Defensiveness
- Expressing reciprocal anger
- Withdrawal from the relationship
- Denial of their own behavior
10
Q
How should a provider manage an angry pt?
A
- Elicit the patient’s reason for being angry:
- Empathize with the patient’s experience:
- Solicit the patient’s perspective:
- If appropriate, apologize
- Educate pt
11
Q
What are the signs of a “silent pt”?
A
- Patients offer little verbally, but the non-verbal cues are very important
- Patient seems withdrawn, fails to make eye contact, distracted, or not acknowledging the providers attempt for interaction
- Patient can also appear anxious, with nail-biting, pacing, or folding and refolding papers
- Patient can appear sad, with deep sighs, red eyes, and tears
12
Q
What are potential cause of a ‘silent pt’?
A
- Adverse reaction to prescription medication
- Alcohol or other drug intoxication
- Alzheimer or other dementia
- Anger
- Cultural or language barrier
- Depression
- Distraction secondary to depression
- Fear
- Hearing Impairment
- Passive or shy personality
- Preoccupation with auditory or visual hallucinations
- Quiet person
- Stroke, TIA
- Taught by authority figures “silence unless spoken to”
- Differences in gender or social class
- Mistreatment in previous medical relationship
- May represent denial
13
Q
How should a ‘silent pt’ be managed?
A
- Explore the behavior by using reflective statements
- Explain the reason why it is important to collaborate with provider
- If patient distracted, ask about hallucinations
- If patient nodding head a lot, could be related to hearing impairment
14
Q
How should a silent pt be educated?
A
- Explain that silence create a barrier to effective care
- Emphasize the importance of becoming involved in their own health care
- Explain that the provider doesn’t solely make decisions, that it is a team effort
15
Q
What are the signs of a ‘demanding pt’?
A
- Patients make requests or demands for diagnostic tests, referrals, or for specific treatments
- Sometimes their demand is for secondary gain
- Patient is frustrated with lack of relief
- Often providers feel rejection, distrust, blame, or humiliation due to demanding patients. This leads them to become defensive.
16
Q
What are the potential causes of a ‘demanding pt’?
A
- Anger
- Fear
- Frustration
- Personal responsibility for health outcome
- Doubt
17
Q
How should a demanding pt be managed?
A
- Don’t respond to the presumed cause, evaluate or reevaluate the demand to identify the patient’s affect
- You may ask, “How had you hoped I could help you?”
- When providers believe that the demand is related to secondary gain, they can gently confront the patient and offer a plan that provides ample time for recovery
18
Q
How should a demanding pt be educated?
A
- Patient respond to instructions when they believe it will be helpful in solving their problems
- Once patient’s concerns are met and partnership formed, they will benefit more from the information the provider is giving
19
Q
What are the signs of the “Yes, but” pt?
A
- Non-verbal behavior is usually engaged when problems are being discussed
A. Leaning forward, bright affect, and dynamic gestures - When discussing evaluation & treatment
A. Withdrawn, no eye contact, language become less animated - Verbally during discussion of evaluation & treatment
A. Becomes quiet, volunteers little, and has no solution to problem - After provider makes recommendations the often respond
A. “I’d like to do that but….”
20
Q
What are potential causes of the “Yes, but” pt?
A
- Passive-aggressive behavior
2. Hx of emotional, physical or verbal abuse
21
Q
How should the “Yes, but” pt be managed?
A
- Patient must take responsibility for their own health
- Ask patient what they think would be helpful in solving the problem
- With passive-aggressive behavior the provider can seek agreement on the nature of the problem, and then make a specific contract for what the patient will do
22
Q
How should the “Yes, but” pt be educated?
A
- Once patients given information about collaborative model and understand it the outcome is great
A. Most find the approach satisfying, engaging, and motivating - Those with passive-aggressive behavior can begin a process of introspection and self-awareness
23
Q
What are the indications for referral of a difficult pt?
A
- Inability to make a diagnosis
- Objective assessment that patient is not benefiting from evaluation or treatment
- Provider’s feeling of being threatened or in danger
