Surprising insights into tough patient interactions

It's not something most readers would notice, but I make a conscious effort to avoid terms such as "deal with," or "handle" in connection with patients, physicians and anyone else who isn't immediate family.

So I assure you that the label "manipulative help-rejecting complainer" appearing in one of this week's top stories was not my creation. It comes from a piece in the newly launched Neurology: Clinical Practice entitled "Managing difficult interactions with patients in neurology practices." Neurology is not a publication I'd ordinarily think to peruse for FiercePracticeManagement, but it seems to me that the scenarios described in the piece represent an amplified (or maybe spot-on) version of the tricky, frustrating interactions physicians of all specialties experience in their practices every day.

These are the visits that stretch way over schedule (and your patience). These are the patients for whom nothing you ever do is good enough, for whom you go ahead and order that scan or lab test just to avoid being sued. These are the patients that call at all hours, exhaust you and your staff and yet refuse to take their medications or follow instructions.

But contrary to the villainous-sounding "entitled demander," "dependent clinger," "self-destructive denier" and, yes, even the "manipulative help-rejecting complainer," most of these patients, at least according to the authors, suffer from a profound sense of fear or hopelessness. While some of their behaviors may stem from mental-health problems, they essentially come from scaredy cats lashing out.

And according to the article, one of the main factors making patients skittish is the healthcare system itself. "Concurrently, system-wide pressures to decrease healthcare costs and increase physician productivity lead physicians to spend less time with patients; so doing inadvertently reinforces patients' reliance on nonmedical sources of education, support, and treatment and thereby diminishes further their confidence in physicians and the healthcare system," authors David B. Arciniegas, MD, and Thomas P. Beresford, MD, write. "Inevitably, some patients manifest their frustration and dissatisfaction by becoming demanding, hostile, and even threatening, and, consequently, are experienced and labeled by those caring for them as 'difficult.'"

Obviously, we frequently write about how these stresses affect physicians, but the potential implications on the patient side were eye-opening for me. Without recognizing the relationship, the cycle of frustration between doctor and patient could very well be endless.

The next time you are confronted by a patient's bizarre or upsetting behavior, take a moment to consider what may be causing it. According to the Neurology piece, the most important thing you can do next is assure the patient that you are on his or side--that you are in this together.

When you really consider all the factors involved, that notion may be truer than you think. - Deb