Get ready to deal with the reality that not all patients are pleasant and appreciative of our work as clinicians. Some patients are downright rude and insult us because of our youth, experience, or demographics. Dealing with such patients is at the least a challenge. At the most, it can interfere with good judgment.
Stress and burnout can increase when interacting with difficult patients. Learn how to identify and address issues of burnout through our Simulation.
Schuermeyer et al. identify four categories of patients that can contribute to burnout, as well as strategies to deal with such patients. Although the vast majority of patient interactions are positive experiences, it’s important to be prepared for encounters that result in increased frustration and potential career regret. Having a strategy to deal with such patients beforehand is a more reasonable way to address this potential instead of waiting until such a patient shows up to devise a plan to de-escalate an unpleasant situation.
Schuermeyer Isabel N, Sieke Erin, Dickstein Leah, Falcone Tatiana, Franco Kathleen. Patients with challenging behaviors: Communication strategies. Cleve Clin J Med. July 2017;84(7):535-542. doi:10.3949/ccjm.84a.15130.
The article categorizes such patients into 4 groups:
- Information-rich and information seeking patients – the know-it-all patients or those who want to know it all, often with Internet articles in hand
- Hostile, angry, demanding patients – they often request that “incompetent” people like medical students and residents not be involved with their care
- Needy patients who demand more and more of your time and reassurance – with little benefit or decrease in their neediness
- Self-injurious patients or patients who feign illness for external gain (e.g., admission to a hospital) – attention-seeking behavior leading to wasted resources
Without a strategy to respond in these situations, the risk of burnout is high. Our sense of personal accomplishment (a factor in burnout) is tied to the feedback we get from patients. Patient feedback is how we know if we are doing a good job. If a patient says we are ignoring science, keeping them in the dark, incompetent, or insufficient to meet their needs, our sense of accomplishments may be harmed. Similarly, a feeling that we are not helping patients may harm our personal sense of accomplishment. Since these patients often suffer and receive lower quality and ineffective care because of the above styles, they do indeed lead to a provider being less effective.
The experience also leads to emotional exhaustion, depersonalization, and detachment from patients in general – the other hallmarks of burnout. Dealing with the difficult patient is a skill you must master. And each group of patients requires a different strategy. More importantly, you need to prepare for these experiences before they happen.
Practice is essential. However, seeking out difficult patients isn’t an attractive option. Simulated experiences can help recognize such patient early on and provide an opportunity to practice patterns that are more likely to succeed in decreasing your stress and improving patient engagement.
In addition to our immersive, game-based VR experience discussed above, our Clinical Encounters Platform provides a solution for the broad ecosystem of educators to create and medical students to experience case-based learning. In the Clinical Encounters experience students interact with patients based on data and written dialog and make care decisions from diagnosis to consultation. Cases mirror pleasant and unpleasant patient encounters, the cognitive challenge of diagnosis, and ethically challenging situations where the process of care limits the ability to act in the patient’s best interest. The simulation helps the learner assess if a conflict exists and offers a means to resolve the conflict or simply to acknowledge it. The reader application is available for PC, Tablet and Phone.
Educators can easily create cases that highlight the data of medicine as well as the patient communication aspects with our PC-based writer application and upload them to the platform to distribute to students and other learners. You can read more on the Clinical Encounters website.