“There are no difficult patients; only patients with difficult problems.” I learned this mantra from a colleague and have used it to help shape my practice for quite some time now.
A few recent comments online about “difficult patients” have bothered me. When I tweeted a similar quote the other day, one person on Twitter insinuated that I was naive to say this. One medical website even has a subsection under “Patient Relations” called “Difficult Patients”. Kevin Pho blogged about a similar issue recently, as has Dr. Maria Yang. My take is somewhat different, but the basic premise is the same.
This is by no means a naive philosophy. The simple statement can be applied in every situation. The concept of a “difficult” patient is, well, difficult to comprehend. In whose mind is the patient difficult? Invariably, in the treating physician’s mind, but like many things in medicine, the concept can have different meanings for different observers.
Kevin Pho’s post referred to a study by Hinchey and Jackson published this month in Journal of General Internal Medicine, that explored both patient and physician factors in situations where patients are considered “difficult”. You may have your own ideas of what makes a patient “difficult” that are not addressed exactly in this article.
Instead of considering the patient “difficult” in the first place, I would suggest another approach when faced with such a patient:
Try to understand what is driving the behavior or the situation that makes the patient seem difficult.
I couldn’t possibly list all of the possible reasons that might make a patient seem difficult, but here are a few options to consider:
- The behavior that you consider difficult is patterned from early life experiences
- The patient is worried about a serious problem but hasn’t told you
- The patient doesn’t feel “listened to” by the healthcare system or other doctors (or you!)
There are innumerable other reasons I’m sure you could come up with. However, ultimately the underlying reasons for the “difficulty” are usually not things that the patient can control without external assistance. Even in the unusual situation of Munchausen syndrome, in which patients harm themselves for secondary gain, there is a significant underlying disorder that warrants discussion and treatment.
Next time you are faced with a patient you find “difficult”, try considering why you are feeling that way, and explore what the driving force behind the patient’s situation might be. You will open up the relationship with your patient and hopefully improve your patient’s outcome.