The National Institutes of Health estimates that 10 to 20 percent of patient interactions are “personally difficult,” with many other medical authorities pinpointing the figure at 15 percent. As part of a long shift, one particularly disruptive patient can be exhausting and consume time, resources and emotions to little effect. Some simple strategies, however, can help ensure you provide the best care possible to all of your patients.
1. Know Your Institution’s Policy and Guidelines
Difficult patient interactions have been a topic of study for decades and are an acknowledged challenge in the medical field. Most hospitals and healthcare providers – general practitioners and specialists alike – have established policies defining difficult patient behaviors and how medical professionals should address them. In a report released by the Committee on Physician Health and Wellness, the first piece of advice was to know your professional organization’s policy and to document all encounters accordingly, as soon as possible. A busy 12-hour shift can become a blur of needs and tasks, but find time to record interactions, even if it’s just adding a brief comment into a care record.
2. Put Safety First – Ask for Help
Some patients may be difficult and become abusive due to trauma, fear, prescription drugs or illegal substances, psychiatric or psychological disorders, or inability to communicate or understand what is happening. Disruptive patients can be a danger to themselves and other patients and medical staff, both directly and indirectly through diverted resources or delayed treatment. The American Academy of Family Physicians recommends learning to recognize the early signs of frustration or anger, particularly noting patients’ body language. Sometimes, even the best efforts to defuse a situation may be unable to deter a patient. Especially in those cases, collaborate with colleagues, and keep chains of command informed.
3. Remain Professional
Not taking patient behaviors personally is key. In a study published by the Journal of the American Board of Family Medicine on “How Respected Family Physicians Manage Difficult Patient Encounters,” more than half of the physicians stated that “recognizing and dealing with their emotions was an important part of coping.” Being aware of the impact a patient’s behavior has on your emotions is as important as recognizing that you probably have little control over whatever initially upset the patient. Medical care is a team-oriented, high-demand discipline. Many times, the source of patient frustration may begin with family conflicts or time spent waiting, events over which you have no control, and escalate from there. Most likely, the patient doesn’t know you or anything about you, but you may still be a “safe” target for their anger.
4. Communicate With Patients
An article in the American Medical Association Journal of Ethics titled “Who Is Being Difficult?” highlighted that “a difficult patient-physician relationship emerges from the conflicting expectations and misunderstood behaviors by both patient and physician.” The BATHE technique is a commonly used one-on-one tool that utilizes a questioning approach to encourage a constructive patient-caregiver dialogue:
- Background – Ask what has been happening, and let the patient explain.
- Affect – Ask how the patient feels about the background information they’ve provided. Simply being asked may offer patients relief and reveals their emotional state.
- Trouble – Ask the patient what troubles them most. It focuses the patient, and you, on prioritizing what is important. It may be a small problem easily resolved.
- Handle – Ask the patient how they’ve been handling the situation so far. This conveys a sense of respect from you that the patient has been able to cope.
- Empathy – Express understanding of the patient’s difficulty. Simply acknowledging that a specific problem is difficult may prevent many misunderstandings and frustrating encounters.
5. Maintain Compassion
The Journal of Clinical Nursing cited a study by Louise Bramley and Malika Matiti that examined patient experiences with medical care. Even though many “actions of care . . . often take time,” even fleeting moments established a compassionate connection; the giving of time was a primary perception of compassion. Consider a list of issues for difficult patients, and you’ll see challenge after challenge, some physical, some not, but all very real: difficult diagnoses, workmen’s compensation, psychiatric disorders, chronic pain, multiple medical issues, family conflicts or even substance abuse. Patients may have difficulty communicating because of hearing loss, disorientation or even language barriers. Older patients may be frustrated by their loss of independence or lack of mobility. The most difficult patients often demand more time simply because they need more time – and compassion.
Difficult patients come in every gender, race, ethnicity and age as well as other identifiers. The greatest challenge to medical professionals, however, is not how to survive one shift with a difficult patient or two but how to survive the shifts that will follow through the passage of weeks, years and, for the truly dedicated, decades. At the heart of it all is the never-to-be-forgotten reason why you wanted to become a health professional in the first place: You wanted to be of service to the world and heal people. Sometimes, that means one difficult patient at a time.