What are some questions I can ask to manage difficult encounters?
- How do you think I might be able to help you (or how did Dr... think that I might be able to help you?)
- What are your expectations of this consultation (or of me)?
- When did you last feel perfectly well?
- Is it distressing for you to discuss this issue?
- What do you think is the cause of your problem (or symptoms)?
- Have you known other people with this condition (or these symptoms)? How did they fare?
- What do you already understand about your illness (or symptoms)? What have you been told and what have you learned about it yourself?
- Do you understand what is planned? How do you feel about this plan?
Patients' perceptions of being given time for an adequate
and genuine hearing may diminish anger in these situations and lead to
reasonable dialogue.
Listening, conducting a physical examination, arranging
limited investigations if appropriate and providing ample reassurance is sound
medical practice.
Over-investigation may be harmful, as asymptomatic findings
not relevant to the current problems, such as gallstones, uterine fibroids and
ovarian and hepatic cysts, may result.
In due course, when trust is established, finding time and
ways to explain the links between the mind and the body may assist some of
these patients.
Personal awareness and self reflection are terms that should
encourage physicians to think about not only difficult interactions but also
who they are, their temperament and personality and what it is that makes them
the sort of doctor they are or aspire to be.
Overall Tips and Tricks For the Difficult Patient:
Core Principles to remember in a difficult patient encounter:
- Make your relationship with the patient, not the "disease," the target of change
- Focus the discussion on patient's emotional experience
- Allow the patient's perspective to guide the clinical encounter.
Two Mnemonics to Boost Your Patient Communication Skills:
1) NURS is a reminder to:
N - Name the patient's emotion
U - Understand ("I can see why you feel this way.")
R - Respect (You'v been through a lot and that takes a lot of
courage.")
S - Support ("I want to help you get better.")
2) BATHE can help you learn more about the patient's
situation:
B - Background ("What has been going on in your
life?")
A - Affect ("How do you feel about that?")
T - Trouble ("What troubles you the most about this
situation?")
H - Handling ("How are you handling this?")
E - Empathy ("That must be difficult.")
Teo, A. R., Du, Y. B., & Escobar, J. I. (2013).
How Can We Better Manage Difficult Patient Encounters? The Journal of Family
Practice, 415-417.
