is unlikely that all of the physicians
were problematic. It is more likely
that the patient is the source of the
problem, and it is unlikely that you
will be the knight in shining armour
that diagnoses a difficult condition or
cures the patient of his or her malady.
very early in the doctor-patient
relationship. Patients with chronic
medical problems lend themselves
to having difficulty with physicians
and their staff. Patients who make
frequent office visits (more than
would be expected for their medical
condition) may be difficult to manage.
multiple medications, especially
analgesics. Studies have pointed out
that patients who insist on being
prescribed an unnecessary drug are
likely to present a challenge and be a
management problem.
articles and citations gleaned from
the Internet. I suggest that you do
not dismiss the patient's efforts as
it only demonstrates the patient's
interest in his or her medical condition.
I recommend that you direct the
patient to credible websites or refer the
patient to your own website if you have
information on the medical condition.
that the patient review sites that I
deem authoritative and credible. I
then offer to discuss the information
or the articles on the next visit. This
way I don't discount the patient's
efforts but rather lead him or her to
information that will be useful and
not confusing or misleading.
discouraged from entering blogs
with other patients. It is has been my
experience that blogging lends itself
to confusion. Well-meaning patients
who have the same diagnosis will give
your patients advice that may not
apply to their disease or condition. For
that reason, I suggest that they avoid
Internet blogging.
RESPONSE TO MANAGING
THE DIFFICULT PATIENT
Murray R. The general approach to
the difficult patient. Emerg Med Clin
North Am. 1998;16:689-700.
or her discussion without any
interruption on the part of the
physician. During the average patient
encounter, the physician will often
interrupt the patient after only 16
seconds
the physician about his or her negative
experience. Make every effort to
remain focused, listen to the patient,
and do not interrupt until the patient
is finished with his or her dialogue.
concern, validate the frustration
with empathy. Rather than
becoming defensive, consider saying:
"I understand that you are upset
at having to wait, and I apologise for
the delay."
the solution
will be amazed at how many times the
patient will give you the answer or
problem. Ways to involve the patient
include asking the patient, "What do
you think I should have done?" or
"Do you have any suggestions of how
to solve this problem?"
listening to the patient's concern and
that you are committed to making
the situation better. Involving the
patient also demonstrates that you
are interested in his or her goodwill
and that you care about the patient's
experience with you and your practice.
opportunity to discuss concerns
don't know what additional concerns
patients may have. For example,
patients may be concerned that the
situation not be repeated with either
themselves or with other patients.
This is of particular importance when
there has been a complication or with
errors of commission or omission.
their fellow patients, and want
reassurance that the situation will
not be repeated.
has been made. For example, if a lab
test was omitted or the wrong test was
done and the test has to be repeated,
patients want to know that they or
their insurance company won't be
charged if the error occurred in your
office or at the laboratory.
the radiologist didn't check the film's
quality after the study. The radiologist
had to bring the patient back for an
additional mammogram, and she was
charged for the additional study.
members, friends, existing patients and potential
new patients about their negative experience
with your practice.