Question

Have you ever looked at the doctor's perspective in regard to difficult patients? Have your readings convinced you that doctors have as much difficulty with patients as patients have with doctors? Give a detailed response, referring to your readings and viewings.

- DO NOT USE SHORT SENTENCES, Write a full detailed paragraph!

Answer 1

Difficult patients:-Fifteen per cent of clinical interactions with patients are perceived as “difficult” by doctors.Doctors can feel pushed to their limit when they encounter a “difficult” patient." several factors contribute to making a patient interaction challenging. Understanding the reasons behind these challenging interactions is a helpful first step in reducing their frequency.

The factors that contribute to a difficult situation:-The factors that contribute to a difficult situation can come from many sources, but can be broadly grouped into the following categories:

(1)patient,

(2.)doctor,

(3.)disease, and

(4.)system.

Being aware of these factors and taking steps to reduce them could help to prevent difficult interactions from arising. Labelling the “interaction” rather than the “patient” as difficult creates opportunities to influence our perception of that difficulty.

(a) The patient:-Patients can be uncooperative, hostile, demanding, disruptive, and unpleasant (although it is important to remember that patients may think that doctors also show some of these same characteristics). They might have unrealistic expectations or be unwilling to take responsibility for their health. All these factors can contribute to making an interaction with such a patient a challenging experience.

(2.)The doctor:-Interactions can be more difficult if the doctor is hungry, angry, late, or tired (HALT). Personal factors could be a distraction for some doctors, and in other cases the doctor’s personality traits could clash with those of the patient. In addition, it can be easy to stereotype or label certain patients or their behaviours, which might influence the doctor’s perception of the difficulty of the consultation.

(3.)The disease:-Some conditions can be more challenging to deal with—such as chronic pain, ill defined diagnoses, or those with little prospect of improvement. The difficulty inherent in managing a particular disease can make the interaction with the affected patient feel more challenging than consulting with a patient who has a more straightforward condition.

(4.)The system:-Limited resources, finances, and support, as well as time pressures and interruptions, all contribute to the difficulties experienced by doctors.

Bad effect of difficult interactions:-Difficult interactions with patients can take up a disproportionate amount of a doctor’s time, resources, and emotional energy. They can cause the doctor to feel stress, anxiety, anger, and helplessness, and can even lead to a dislike of the patient and the use of avoidance strategies. This response could compromise the doctor’s ability to give good care and put the doctor at increased risk of making mistakes, which can affect the clinical outcome for the patient.

A difficult interaction will leave both the doctor and the patient feeling frustrated and dissatisfied, and can decrease the trust in the doctor-patient relationship. As a result, the patient may be more likely to ask for an appointment with another doctor in the practice for a second opinion, or turn up at the emergency department in hospital, which ultimately leads to higher use of healthcare resources.

Dealing With Difficult Patients:-There are two ways to handle a difficult patient:

(1.)The first approach is that a particular patient is always demanding, and you do not have to listen to him/her.

(2.)The second approach is to spend extra time with that patient. You listen to the patient carefully, explain the problem and offer a solution.

However, sometimes – no matter how much time you spend listening and delivering good service – it is just not enough. There will always be patients who are not satisfied with your time and service. The key is to handle these situations head-on while serving your other patients and protecting your integrity at the same time.

Case study difficult patient:-

Mrs Whitney had asthma, hypertension, and a history of deep vein thrombosis, for which she was on regular drug treatment. She was poorly compliant with the nurse led review clinics and the monitoring of her conditions. However, she would regularly demand emergency appointments to see a general practitioner at which she would inevitably request new prescriptions, claiming to have lost or run out of her inhalers and pills. She would be rude to reception staff and refuse to leave the consulting room until she got what she wanted.

Dr Hopkins found himself dreading Mrs Whitney’s name appearing on his clinic list. He realised that he was rushing to end the consultations with her to avoid confrontation, and was prescribing drugs for her when it may not have been in her best interests to do so.

Dr Hopkins raised the issue at a practice meeting and discussed ways of dealing with the problem with his colleagues, whom he found supportive. It was agreed that boundaries needed to be set for Mrs Whiteney around the use of emergency appointments and behaviour towards staff, and her repeat prescriptions would be monitored. These decisions were shared with all members of staff so that they could be applied consistently.

The boundaries were explained to Mrs Whiteney in a way that helped her understand that they were being set in her best interests. Although Mrs Whitney did not turn into the perfect patient overnight, having the boundaries in place made Dr Hopkin feel better able to deal with the consultations and hence to manage Mrs Whitney's health needs.