PART 3. DIFFICULT PATIENTS, WHO ARE THEY?
First, I must define what I mean by “difficult patients” because this is a controversial topic, and the definition of difficult patients changes from doctor to doctor.
As I see it, difficult patients are those who personally or by their family members, trigger a negative feeling or anger in the doctor, by their talk, choice of words, tone of voice, demands and/or behaviors. I personally try to avoid these types of patients and do not want them to become my patients, and do not establish doctor – patient’s relationships with them. Despite all of this, I too have had my shares of difficult patients. Clinical studies done on this topic have shown that there are about 12 – 15 % difficult patients in every practice.
I thought it will be more instructive if I give real life examples of difficult patients from my own practice. They include
-Patients who do not pay their bill but insist having the same medical care by insinuating abandonment or lawsuit if they are not given the next appointment.
-Patients who demand to have certain medications, tests and procedures they have herd from a friend, or TV advertisement, or the internet. I am very much against drug advertisements on TV. It does nothing but to increase the cost of the drug, cause inappropriate use of drugs and make doctors upset.
-Patients who lie and fake a disease to obtain medication they are addicted to.
-Patients who suffer from mental illness with paranoia and psychosis could be disruptive. I remember being punched by one of them.
-Patients with psychosomatic illnesses, functional gastrointestinal disorders, or “worried – well” patients who insist frequently to be seen, and having more tests done.
-Patients who are lonely, and the only human contact they have is with office visits.
-Patients who want to have urgent medical care, but without any personal information given, and no office record kept. I thought I must give some more details about this interesting case. One day a font office girl walked in my consultation room and said, “a young man with rectal bleeding wants to be seen without any information or office record kept. He will pay cash. I think he is a member of local Mafia, and hiding from police. What do you want to do?” I hesitated to see him. But then, I thought in medical emergency we even must help our enemies. So, I decided to examine him, and did a Proctosigmoidoscopy. He had bleeding internal hemorrhoids.
I believe in adversarial difficult patients encounter. The doctor should take the upper hand by training and experience dealing with people and knowledge of human psychology, by staying calm, controlling their anger and other emotions. I was lucky enough to learn how to control my ager since my childhood. I was raised in a strict Circassian culture called Xabze. My father used to tell me that A real Circassian man (Adige) never raises his hand against a woman, feels but never expresses anger, fear, weakness and frustrations.
Difficult patients encounter, together with difficulties, created by health insurance companies and Governmental bureaucracies are the main culprits of early burnouts, and retirement from the practice of medicine.
