As the demand for care rises steadily and healthcare organizations struggle to keep up, patients and healthcare practitioners are finding themselves increasingly at odds. On one hand, patients become frustrated with longer wait periods in accessing the care they need with clinicians seemingly too busy to listen. And the other, clinicians daily face the limit of their emotional (and physical) endurance in juggling what are often conflicting priorities, limited resourcing, and seemingly unending patient loads. The result – impaired communication – ultimately negatively impacts the quality and efficacy of care patients receive.
In this blog, we’ll examine some fundamentals in understanding how providers can improve their patient communication protocols such as:
- Elements that contribute to challenging patient encounters
- Main types of difficult patients
- Tips for dealing with difficult patients
“I would have liked to have asked [the doctor] a few questions, but she didn’t really give me that opportunity.”
— Howard, age 65
Elements of a Challenging Patient Experience
Though the factors that play into developing difficult patient encounters may vary case-by-case, according to the American Academy of Family Physicians, there are three top items to consider that feature consistently:
- Situational Issues – Language barriers and literacy issues, multiple people in the exam room, presentation of negative news, environmental issues (e.g., noisy, chaotic, lack of privacy).
- Patient characteristics – Patient state of being and attitudes during visit involving any or all of the following: angry/defensive/frightened/resistant, manipulative, somatizing, grieving, “frequent fliers” (see next section).
- Physician characteristics – Physician state of being and attitudes during visit involving any or all of the following: angry/defensive, dogmatic or arrogant, fatigued or harried.
Main Types of Difficult Patients
Four prevalent types of patients that your practice may be challenged by are:
#1: Manipulative Patients
From using guilt and rage to threats of legal action and attempts of suicide, these patients seek to get what they want, which makes accurately differentiating them from those authentically suffering from borderline personality disorder particularly difficult. The impulsivity displayed by manipulative patients will require emotional awareness on the part of healthcare professionals as well as proper management of the patient’s expectations, including saying “no” when it is warranted.
#2: Somatizing Patients
“Doctor shopping” is a common practice for these patients. They are characterized by often manifesting – or somatizing – a selection of vague complaints or exaggerated symptoms. Comorbid anxiety, depression, or personality disorder may play an active role in this patient type. Successfully handling somatizing patients lies in compassionately presenting any diagnosis information while accentuating to the patient the importance of the regularly scheduled visits with their primary physician as a means to alleviate any health-related concerns.
#3: Angry/Frightened/Defensive/Resistant Patients
This patient type is usually easy to determine with agitative behaviors ranging from anger, defensiveness, and fear to hand wringing, clenched fists, and irregular breathing. Though frequently quickly identified by front-end staff (who then provide notice accordingly to the attending clinician), these behaviors can easily “trigger” unprepared clinicians, drawing them into a conflict with the patient. Exercising empathy and defining boundaries are elemental in effectively administering to these patients.
#4: “Frequent Fliers”
From the healthcare provider perspective, the concern regarding frequent fliers stems from the risk of their repeat visit excessiveness unnecessarily tying up already strained (and in some cases, limited) clinical/practice resources.
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Key Strategies in Dealing with Difficult Patients
Regardless of the patient type or given circumstances of a challenging encounter, practicing clear, concise communication enables healthcare professionals to provide consistent, quality care while fostering trust and optimal cooperation with their patients. Here are some effective ways to achieve those:
1. Don’t take it personally.
Whatever negativity or adversity the patient is struggling with at the time of their visit is most likely nothing to do with you. What behavior is witnessed during the encounter could very well be the tip of the iceberg of what the patient is processing internally. As the adage goes, “You don’t know what you don’t know”. Staying focused and maintaining a professional demeanor will go a long way in avoiding defensive posturing and escalation.
2. Stop, look, and listen.
Everyone wants to be heard, and your patients are no different. Allow empathy to help empower your patient delivery and let the patient tell their story. By hearing them, you are better equipped to address their concerns and meet their needs…and the patient’s appreciation will translate to enduring growth for your healthcare organization!
3. Look through the patient lens.
It is safe to say that no one is ever at their best when dealing with a health concern. Asking relevant questions and truly listening to your patients and their body language will help to develop an informed line of sight to your patient’s perspective as well as the underlying causes for their concerns and behaviors.
4. Keep calm and carry on.
Learning to set aside your frustrations and grounding yourself is a consummate life skill, including when handling challenging patient encounters. It is okay feel annoyed and irritated however, staying calm is important to ensuring escalation doesn’t occur. To help you keep your calm and stay emotionally collected, consider exploring healthy coping methods such as breathing and mindfulness techniques (yoga is excellent for this!).
5. B is for boundaries.
As in any situation, abuse is never acceptable. For healthcare providers, it is a good practice to set limits when experiencing patients who engage in aggressive behaviors (e.g., screaming, using profanity). A prime example of clear, defined boundary setting is advising the patient their abusive behavior will not be tolerated and offering to leave the room while the patient collects themselves. By setting boundaries, you help to position your practice for next-level patient care delivery.
For healthcare providers, understanding difficult patient experiences and how to effectively navigate provides a solid foundation in building patient trust as well as foster the delivery of consistent care. At the core, communication is the key and organizations able to facilitate effective communications between their patients and clinicians are better equipped to achieve their patient care delivery benchmarks.
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