How To Manage Difficult Patients

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Author(s): 
By John V. Guiliana, DPM, MS, Hal Ornstein, DPM, and Lynn Homisak, PMAC

Is there a particular patient or two you dread seeing in your office? If a vote took place among physicians as to what kind of patient provokes the most distress in healthcare providers, we would bet many providers would answer “patients who fail to comply.” In fact, providers often react with anger and frustration when patients ignore their professional recommendations.
Aside from the potential legal ramifications, a patient’s lack of compliance often triggers feelings that our professional opinion is devalued and may even cause us to begin to question our own self-worth. When our own self-esteem is under attack by a non-compliant patient, we may unleash our anger and frustration by withdrawing from the patient or inducing guilty feelings. It may even cause us to preach to the patient.
By definition, non-compliant patients place their medical outcomes at risk. There are many reasons for noncompliance:
• not convinced of need for care;
• language barriers;
• care is perceived as too costly;
• problem with understanding the treatment plan;
• undesirable side effects;
• personal conflict with the provider; and/or
• philosophical, cultural or religious beliefs.
As we all know, patient noncompliance is more likely to occur when we give advice or treatment recommendations that either negate a perceived positive experience or cause a negative experience for the patient. For example, when you emphasize to a patient that he or she needs to stay off of the foot, it may interfere with his or her positive experience of shopping or playing basketball. Conversely, taking an antifungal medication that could potentially cause some liver problems also may elicit a perceived negative experience.

Why Responding Is Better Than Reacting
When you are dealing with a non-compliant patient, it is essential to control your reactions. Providers should respond and not react. In responding, you consider the true meaning behind the patient’s noncompliance and respond accordingly. This is in contrast to reacting without forethought, which often leads to taking more of an adversarial stance or position.
Responding requires active or empathic listening skills. Ask youself what the patient is really saying. Why is he or she saying it? In other words, we must listen carefully in order to identify the patient’s real motive for noncompliance. Indeed, if you deal with this directly, you’ll have a far better chance of converting the difficult patient to a compliant one.

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