How To Handle Difficult Post-Op Patients

By John V. Guiliana, DPM, MS

Difficult patients are challenging enough but when the difficult patient is also a postoperative patient, the challenge becomes a medico-legal risk. Difficult patients are not difficult because they have special medical needs. They are difficult because they challenge our defenses, stretch our tolerance and patience, or demand much more of our time than we can give. However, it is possible to care for these challenging patients if you know how. Taking on a difficult patient can spiral into a battle of wills and wits that you are destined to lose. That is why it is necessary to understand your own limitations and personality. You have to manage your emotions and be as professional and calm as possible, regardless of what your patient says or does. It is important to avoid emotion that clouds your judgment and over-personalizes your interaction with the patient. This takes practice and a willingness to learn from mistakes. When A Patient Has Unrealistic Expectations When it comes to a patient’s unrealistic expectations, it is obviously best to manage this in a proactive manner. For surgical candidates, knowing the medical and psychiatric history of the patient is the bare minimum. You have to understand the patient’s past patterns of behavior in order to ascertain future behavior. These patients (or their families) demand results and need to be kept up to date on the specifics of their treatment. They often attempt to have control over every aspect of their care. Try to build trust early on in order to avoid future conflict. Acknowledge that you are a partner in the patient’s care but that you are also a trained professional with a set of skills and specialized knowledge. Avoid the appearance of condescension. Be thorough with explanations and be sure to dispense patient education handouts about their condition or proposed surgery. Informed consent should be very thorough. An informed consent is a shared decision between you and your patient. This is not a task to delegate to your office staff. Having the patient sign a long list documenting potential risks and complications without a full discussion with the surgeon is not an informed consent. Informed consent occurs when you have explained, and the patient understands, the diagnosis, recommended treatment, alternative treatment, expected outcome, the risks and complications, and the benefits and risks of doing nothing. Use terms that the patient understands and use a translator if necessary. Document the discussion and note if others (such as family) were present. Keys To Interacting With Frustrated Or Angry Patients Anger is a common emotion expressed by patients and their families. The most typical reaction by health professionals confronted by the angry patient or family is either to get angry themselves or to withdraw physically and psychologically. Neither is a helpful coping strategy. Look for the underlying source of anger. Fear and frustration are probably the most common sources of anger, especially during times of pain or suffering. The anger is often released on the healthcare provider and staff. Other sources of anger may be genuine (e.g. waiting six hours to see the doctor). It is important to recognize the direction of anger. Recognizing the difference between internal and external anger is critical to effective management because internal anger may lead to potentially harmful patient consequences. The patient may direct his or her anger internally because of fear and guilt. You may hear the patient admit that he or she is not taking care of him- or herself. Other patients may express concern that they feel they are abandoning their family or job. This internally directed anger could lead to withdrawal, self-neglect, anxiety, depression and/or a combination. Others may direct their anger outward toward physicians. In either case, one should engage rather than withdraw from the patient. The natural tendency for the physician or health professional is to cut short the office visit, find ways to avoid contact with the angry patient or family member, or try to mask his or her own anger in order to continue to interact with the patient. Speaking with other colleagues about the situation (without violating HIPAA) is often insightful and can help relieve the stress of the situation. Occasionally, a postoperative patient may become angry over the financial burden that may result from undergoing a surgical procedure.


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