Communication Skills: Dealing With Difficult Patients

Communicating with difficult patients is a challenge for all physicians. Doctors practice patient communication skills beginning as early as the first year of medical school with videotaped mock patient interviews and precipitator feedback to get it right.

The distrusting patient

Yet, there are some patient interactions that can leave even the most emotionally intelligent and well-coached physicians overwhelmed—and sometimes even frightened. It is important that doctors who take care of patients anticipate these types of inevitable interactions in advance and work towards solutions that promote peace of mind for everyone involved. The patient who says, “everybody lies. I know they are hiding something,” can make you feel like you just can’t do or say anything right. When a patient tells you that everyone is out to get them, it can be difficult to decipher whether the patient is inherently skeptical or whether they have been treated with dishonesty.

It helps to lean on teamwork in these situations. Feedback from other members of the healthcare team can help you sort out whether a patient truly was not given complete information at some point during their care or whether they are mistrusting of others without a solid reason.

The exception

As a solution, it helps to suggest resources to your patient—such as online access to their charts so that they can follow their own results. You can also make your medical notes and correspondence regarding their medical care available and accessible to them so that they can follow along and promptly double-check everything that you are doing. When you have a patient who insists that, “my body doesn't work like everyone else's,” or “don't try the same things on me that you use with other people,” you may be in for a tough road.

Each person is unique. Patients’ health can certainly be complicated—computers can’t be programmed to safely take care of real patients because people are individuals and do not function like robots. But, it is a basic cornerstone of medical science that the human body tends to follow physiologic rules. When a patient is allergic to everything or has symptoms that don’t make sense, it can be hard to distinguish between a medically challenging case and a patient whose perceptions don’t match up to reality.

Acknowledging the uniqueness of your patient’s experience can provide them with validation. However, this validation has to be balanced with a reassurance that even exceptional people usually experience improvement with standard medical treatment.

The angry patient

Another strategy that can be useful when taking care of an exceptional patient is to consider getting your patient’s permission to present their case at a conference or as a case report. If your patient feels isolated and unheard, this type of specialized medical “crowdsourcing” can help you and your patient find answers to perplexing questions. When your patient starts your visit with statements like, “I want to get them fired,” or “I want to shut that place down,” it can color your perception of your patient’s medical problems. Even the most intuitive and empathetic doctor or nurse may have trouble differentiating actual medical ailments from health complaints that are exaggerated to get someone into trouble.

And you may be worried about your own professional viability, potentially becoming more concerned about how a patient may try to harm you than about actually helping them. These types of interactions can be exceedingly stressful.

Family conflicts

It is helpful to ask team members to be present at patient visits. Using communication strategies that make your goals clear is another important approach when it comes to working with an angry patient. Saying unambiguous statements such as, “we would like you to describe the change in your pain level because we want you to feel better,” or “we would like to work with you to find the cause and solution to your health problem,” may not seem to flow naturally to you, but being clear and explicit in spelling out the plan can help alleviate anger. Family members are often essential in providing support and care for patients. Yet, sometimes families can impede good patient care. Family members have a long history with each other, and they may have a complicated outlook on your patient’s medical condition.

It can be impossible to really know what is going on between family members who have spent years together when you are only spending about half an hour with them in an outpatient setting or seeing them in their most anxious state for inpatient care or surgery.

When it comes to family conflicts, it is best for physicians to communicate in a straightforward manner and to take things at face value. Doctors who presume that they can brilliantly decipher complex relationship issues within minutes can come across as condescending to patients who have dedicated a lifetime to their family relationships.

It is best to explain that it is customary to seek formal permission when sharing medical information with anyone other than the patient. It is also important to ask privately when asking about sharing information—so your patient can answer honestly. Whenever possible, all medical information should be communicated in a language that is understandable to your patient, not tailored to family members.

For example, if a teenager has an illness, then the language used to explain the diagnosis and treatment should be geared towards the teenager—even if their parents are highly educated or have a medical background and understand more technical terminology.

Communicating with patients is a major strength of many doctors, who truly enjoy the doctor-patient relationship. Yet, once in a while, a challenging, or even dysfunctional patient can make it feel like communication is the most stressful part of that patient’s care. Careful communication, often with the cooperation of other members of the hearth care team, can help avert some of the potential problems that can occur in these situations.