On “Difficult” Patients.

Kevin, MD, posted a commentary about encounters with “difficult patients”. He correctly notes that physicians themselves contribute to these interactions. To reduce the likelihood of these encounters, he suggests that physicians would benefit from more training in “psychosocial skills”.

Kudos to Kevin for adjusting his own language by the second sentence of his post: He makes the distinction between difficult patient and difficult encounter.

A vital step in decreasing the likelihood of difficult encounters is recognizing the language we use for these events. The words we use affect our perceptions. Compare:

  • “That’s the liver guy. He’s a complete train wreck!” versus
  • “That man has liver cancer. He has an infection in his blood, needs a mechanical ventilator to breathe, and now he might be having a heart attack.”

The phrase “difficult patient” automatically suggests that the patient alone is responsible for any conflicts or problems during the appointment. Uncomfortable emotions, like helplessness or anger, that the physician may feel are attributed solely to the patient. If only the patient would change, then everything would be fine!

As a result, the doctor may then feel absolved of any responsibility to alter his own behavior to improve the interaction. The assumption is that the physician is right and the patient is wrong.

If we instead label the interaction—rather than a single person—as difficult, this can help both patient and physician to step back, assess what each is contributing to the situation, and work together to resolve it. The assumptions doctors and patients have about each other are often inaccurate and impede cooperation. Using the time to understand, rather than blame, the other person can decrease the likelihood of these difficult interactions.

Doctors, like most people, often assign adjectives to patients because it can be hard to identify and then acknowledge emotions. It is much easier to say, “She is such a difficult patient! She is never happy with her care!” than to say, “I feel angry and helpless when I see her because it seems like nothing improves her symptoms!” Leaving out the subjective “I” gives the illusion of objectivity and professionalism.

Physicians are only human. Sometimes we have bad days; sometimes our “psychosocial skills” aren’t well developed. However, we must do our best to engage and build rapport with patients to provide optimal care. Watching what we say and choosing our words with care is a valuable first step.