CREDITS
By Dr Melane van Zyl
5 Common types of difficult patients
■ The Karen
■ The manipulator/ secondary gain
■ The skeptic/ non-compliant patient
■ The Borderline/ Personality Disordered patient
■ The truly sick patient
The Karen
(privileged rude woman)
The Manipulator
(wants something
other than to get better)
The Sceptic
(the patient that Googles
and rather listen to family and friends)
The Borderline/ Personality Disordered Patient
(all interpersonal interactions are
complicated, sensitive to rejection, self esteem problems)
The Truly Sick Patient
(this one we were
trained to manage- if they listen)
Difficult patient behaviours
■ Aggression- angry, shouting, threatening
■ Passive aggression- refuses to leave or stop talking
■ Or, to a lesser degree- sarcasm, and procrastination, do not follow the treatment
regime
■ Non-compliance- and hiding what they are up to
■ Manipulation- flattering, sweet talk, splitting, bribing
■ Demanding- excessive attention, quicker response, special treatment
When are you dealing with a difficult patient?
■ Behaviours as per the previous slide are usually obvious
But- often, we do not realize we are dealing with a difficult patient!
■ You become anxious and confused- “damned if you do and damned if you don’t”
How to become aware the patient is actually difficult
Often easy (e.g., screaming)
The more subtle signs: look inside yourself
■ Feeling uncomfortable emotions or physical sensations
■ Worrying after hours
■ Doing things that are not standard
■ Dreading to help the patient
Why are some patients so difficult?
■ The underlying medical condition (and maybe fear about it)
■ Personality pathology
■ Lack of insight /ignorance
■ Entitlement- “reverse stigma”- remember the patient does not care about you!
■ They want something other than to get better
What not to do
■ NEVER EVER SPECIAL FAVOURS!
■ Act out of anger/irritation
■ Write or say things/ provide evidence that can be used against you
■ Refuse to help the patient (relative)
■ Break confidentiality
■ Give the patient what he/she wants so they can leave
■ Reason: “If I do not give …… the patient will get it elsewhere anyway”
Managing difficult patient behaviour
■ Buy time- listen, validate, be professional
■ Be nice
■ Professional boundaries
■ Get help/ supervision/advice (even legal)
■ Involve the family
■ Have very clear protocols/ SOPS
■ Treat all patients the same
■ Ask yourself: “Can I defend this in court?”
■ Make notes
Planning to manage difficult patients
■ Download/ print HPCSA guidelines
■ Have security available/ supervisor
■ Private space (so conflict is not in front of other patients)
■ SOP’s
■ Documentation at hand (Ts and Cs, Popia, consent, complaints)
■ Professional bodies/ peer support
■ Contact list (can the patient be referred?/ emergency numbers)
■ Follow up procedure
And if you are brave:
Introspection:
■ Why do I do this job?
■ What are my values?
■ What do I want my patients to believe about me?
■ How much criticism can I tolerate?