46
46
The radiology department did not manage
this properly, and the patient left the
primary care doctor who ordered the study
and the hospital and referred herself to
Mayo Clinic
8
.
Again, asking about patients' concerns
demonstrates your caring and compassion.
After all, patients don't really care how much
you know compared with knowing how much
you care!
A FEW SUGGESTIONS
I believe it is important to have a discussion
with a difficult patient in a private location
where the discussion cannot be overheard by
others in the office. I suggest that you escort
the difficult patient from the exam room to
another secure location in the office to
have your discussion in private and
without interruption.
I recommend that you sit next to the
patient, not across the desk from the patient.
The reason is that you want to avoid any
barriers, including physical ones, separating
you and your patient. You also want to
maintain good eye contact with the patient.
This is not the time to be looking at the
chart or a computer screen. Inform your
staff that you will be talking to a patient and
that you are not to be interrupted during
this conversation. After you have listened to
the patient, it is helpful to ask the patient
additional questions. This sends the message
you are interested in finding a solution and
that you are actively listening.
At the end of your discussion, thank
the patient for bringing the issue to your
attention. You may even consider sending
the patient a note acknowledging your
discussion and your plan of action. If you
have to get back to the patient, specify a day
and time that you will be calling.
If you don't have a response or answer at
that time, call the patient and let him or her
know the status of your follow-up and when
you might be in contact again.
Follow-up is vital to the success of
managing the difficult patient.
SUMMARY
Managing the difficult patient is part and
parcel of the practice of medicine. You are likely
to have satisfied patients who have a positive
experience with your practice. However,
there are going to be a few that will try your
communication and interpersonal skills.
Resolving the issues of the difficult
patient can be gratifying and as rewarding
as solving a difficult diagnostic problem or
successfully resolving a medical problem
using your surgical skills.
Finally, if you can handle the difficult
patient, the others are so much easier
to manage!
IN BRIEF
Dr Neil Baum is Associate Clinical Professor of Urology at Tulane Medical School and
Louisiana State University Medical School, both in New Orleans, LA. He is also on the
medical staff at Touro Infirmary in New Orleans, and East Jefferson General Hospital in
Metairie,LA.Visithttp://neilbaum.com/meet-dr-baumorfollowDrBaum'sblogat
http://neilbaum.wordpress.com/
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4. Jackson JL. Arch Intern Med. 1999;159:1069-1075.
5.SmithRC.UpToDateOnline.www.uptodate.com.
6.KroenkeK.Unburdeningthedifficultclinicalencounter.ArchInternMed.2009;169:333-334
7. Groopman J. How Doctors Think. New York: Houghton Mifflin; 2007.
8. Berry L, Seltman K. Management Lessons from Mayo Clinic: Inside One of the Worlds Most Admired Service
Organizations. New York: McGraw-Hill; 2008.