"Chapter 34: The Difficult Patient"

Via the Difficult Patient blog. Dr. Barron H. Lerner, MD, writes:

It is not easy to delineate the characteristics that make a patient difficult. First, different physicians have different reactions to various types of behavior. In other words, behavior that one physician might find annoying, another might find to be particularly challenging or even endearing. Second, the characteristics of a physician may contribute to what he or she perceives as a difficult physician-patient relationship. Thus, a physician might perceive a patient as excessively demanding when, in fact, the physician or the medical profession may be at fault...

One study found that the most common responses by physicians to difficult patients were feelings of anger and insecurity. What is it about the encounter, the physician should ask, that is engendering these feelings? Assuming that the physician concludes that the problem stems from the patient's personality, it is useful to try and ascertain which of the patient's behaviors are so upsetting. This task is not performed in order to give the patient a derogatory label, but rather to initiate a diagnostic (and hopefully therapeutic) process. Thus, a patient might be characterized as overly demanding, a chronic complainer, or noncompliant.

At this point, it is important to assess the patient's psychiatric status. Does the patient's behavior stem from an underlying psychiatric problem? Important things to rule out immediately are clinical depression or an anxiety disorder, both of which are treatable. Underlying personality disorders, while less amenable to therapy, are nonetheless important to identify. Such patients may be referred for psychiatric consultation. Detection of a psychiatric problem, however, should not be a mechanism for "turfing" the patient to psychiatry. Rather, psychiatric intervention - by the primary physician or the consultant - should comprise one part of the overall therapeutic strategy and most often can be done in the primary care setting...

Difficult Patient says: "While I can't imagine caring for a difficult patient being a rewarding experience, I think that finding a way to help them so that they aren't difficult anymore (maybe it isn't their underlying nature!) would be very rewarding..."