Thursday, July 23, 2009

Seriously, I wanna know...

Sally: I'm difficult.

Harry: You're challenging.

Sally: I'm too structured. I'm completely closed off.

Harry: But in a good way.



When Harry Met Sally (1989)

Are you a magnet for difficult patients? By difficult, I mean patients with threatening or abrasive personalities, who come to the physician encounter with 5 or more complaints, use health services extensively, or have a mental disorder - the criteria used by Dr. An, et al in Burden of Difficult Encounters in Primary Care: Data from the Minimizing Error, Maximizing Outcomes Study. Archives of Internal Medicine 2009; 169(4): 410-414. According to their data, if you are young and female, you are more likely to have encounters with difficult patients. Is burnout responsible? What about multi-tasking? Does our training leave us prepared to deal with medically complex patients but not emotionally, demanding complex? Does the difficult encounter impact outcome?

10 comments:

  1. It's awfully offensive to categorize individuals with mental illness as "difficult" in the same way as individuals with threatening and abrasive personalities.

    ReplyDelete
  2. I am an ER doc. I am therefore a magnet for difficult pts ;). And yes, the emotional complexity (the lack of satisfaction) is tougher, for me, than the medical complexity.

    ReplyDelete
  3. Hell yes. They see me a mile off and make a beeline. However, every now and then you help one, which is rewarding

    ReplyDelete
  4. Chartreuse - Having dealt with several parents in my practice with mental illness - it is sometimes the abrasiveness of the encounters that tip me off to their struggles. I have found this kind of patient to be a real challenge because it takes persistance & compassion to get through the layers, not take it personally, and do my job to the best of my abilities. As anonymous says, when you can help the parent (& child) it can be very rewarding.

    ReplyDelete
  5. The patients with a mental disorder are not trying. But the patients who monopolize your time as well as your staffs, who call repeatedly with the same questions, (not because they don't understand the answers) who can't provide info for the front desk when they call with a message, who come in "knowing" what is wrong with them and simply wanting you to follow your instructions, the patients who want to chat for 90 min regarding nothing at all... THOSE patients make for VERY LONG days...

    and for a much longer time lapse to returned calls.

    ReplyDelete
  6. I'm not a doctor (just a federal civil servant), but I have many customer service encounters with the public. Without exception, the, uh, "crazy" or disturbed ones are drawn to me like white on rice. It gives me great stories for cocktail parties... but sheesh, it is exhausting (emotionally and physically) and I now use voicemail to screen clients--and also as a first line of defense. (I'm tired of dealing with the drunks, the angry ones, the irresponsible ones, the weirdoes, and so forth. If you want a permit, you need to pay for it. No, there are some endangered species you simply *cannot* kill. Etc.)

    Conclusion: I so sympathize, and if you have ANY techniques, I am ALL ears!

    ReplyDelete
  7. Anonymous 2 - the majority my encounters of patients & parents with DSM diagnoses are reasonable & enjoyable. I don't believe the authors meant for mental illness = difficult patient (although I do wonder about their conclusions (& populations studied) since the majority of the authors were male).

    I can think of a handful of challenging encounters that left me wondering if a parent or patient (mostly parent) were undiagnosed or underdiagnosed. If, as the authors suggest, that 1 in 6 encounters can be labeled difficult - I think we have good reason to be tired at the end of the day!

    ReplyDelete
  8. Those cluster B patients... can be difficult. Last I checked that was a DSM diagnosis. I would say it can be easier to take care of the medical problems in someone who has all their mental faculties in place... at least it is definitely one less thing to deal with.

    ReplyDelete
  9. A frustrating reality is that the difficult patients need us more. When you can meet their needs it can be rewarding. If you cannot meet those needs you want to beat your head against the wall. In these cases it is usually not their fault- indeed a psychiatric diagnosis is at play. As far as a magnet for the needy ones- try being a female cardiologist.

    ReplyDelete
  10. Wow, yes, I am a magnet . . . I am young and female and now my suspicions have now been validated! I love what I do, but there are certainly patients that leave me exhausted . . . on average 3 or 4 a day. Before the birth of my child, I sighed and got on with it. Now that I am a mother to a young one, I am finding myself increasingly frustrated with these encounters. I still just try to get on with it, but I do set more limits than before . . . but I know that many of the same patients will blame this on the fact that I am a mother now and too busy to take the time I used to. I absolutely love this site! Brought a tear to my eye this evening reading the blogs of women that just might understand :)

    ReplyDelete

Comments on posts older than 14 days are moderated as a spam precaution. There may be a delay between submitting your comment and its publishing. Thanks for commenting!