Just as people in sales run into all sorts of customers, people in healthcare run into all sorts of patients. Unlike salespeople, though, medical professionals can’t really leave their challenging “customers” alone after a cursory word or two. The Hippocratic Oath might have a little something to say against that.
There are many kinds of patients who seriously try doctors’ and nurses’ faithfulness to the oath, though. Here are just a few of the worst types you can run into.
The Needy Patient
Needy patients appear in all sorts of guises. Some are in the form of the waterspout who bursts into tears at a diagnosis of mild anemia, others in the out-of-office heckler texting you about his non-emergent medical condition 10 times a day.
What do they all have in common? They require more from you than the average patient does, usually in terms of emotional reassurance. It’s normal for patients to seek that from their doctors, yes… but only to a point.
When a patient intrudes on other patients’ time or your personal hours, the patient has become a needy one. How should you deal with him? One way is to clarify boundaries. Talk to the patient yourself and explain what he can and can’t expect you to provide.
You can also try to sit the patient down and have a careful talk with them. Give them the information they need about their condition and tell them what they can do about it. Making them feel more in-control may be a good way to assuage some of the fears driving their behavior.
The Consummate Critic
Ever had a patient who complained about everything from your receptionist’s voice to the waiting room’s décor? When a patient not only makes a point of voicing complaints non-stop but also includes things not really germane to their healthcare in the litany of top grievances, you may have a consummate critic on your hands.
Consummate critics find something to carp about in everything—and they carp about it loudly. Dealing with them can be exhausting, but it’s not impossible. The first thing you need is a lot of patience.
If a patient’s critiques are already making it hard for you to work, though, it may be time to take a slightly firmer stance. This still doesn’t mean losing your cool. Instead, try suggesting to the patient that he or she might be happier at another practice if you’re really unable to meet their standards.
You could even try making recommendations for alternative practices to them. The doctors at the recommended clinic may not thank you for sending the consummate critic their way, though…
This comes about from a common defense mechanism. There are a lot of people who fear being given bad news about their health. For some, they go so far as to resort to denying all sorts of aches and pains just to avoid it. Do they still hurt? Yes. But like the ostrich, they simply stick their heads in the sand.
It’s not very logical, but this sort of thing does happen. The same people also tend to reject “unacceptable” diagnoses when presented with them.
It can be frustrating for a physician who’s trying to help. But the key to dealing with such a patient is to recall that this usually stems from insecurity. In most cases, it isn’t about the patient distrusting the physician or calling his/her skills into question. More often than not, it’s about the patient’s fear.
The fear is that acknowledging one’s mortality (or ailment) only brings its reality nearer. One way to deal with this is to help them realize that it’s only in accepting it that they can begin to do something—treat it, for instance, or work towards a cure. Try to show the patient that accepting his/her condition can actually be a way of him/her taking the power back.
The Amateur Researcher
It’s normal for people to use the channels they have available to get information. That’s why so many people look up things about health on the Internet now. Is this a bad thing? No, for a lot of reasons.
Patients using the Web intelligently can actually make wiser decisions for their care when they are informed. They know better what to look out for and what to do in first aid or home care situations. Where the dangers come in are with the patients who are a little less than discerning in how they do the research.
Examples of these include the patient who believes a diagnosis from a Google search of his symptoms is better than one from a trained physician who has just examined him. Another would be the patient who assumes he knows more about his condition than a medical specialist after just the most cursory glance at “medical blogs” online.
Let’s make it clear: it’s not impossible for a patient to become very-well-informed about a particular condition. But it probably won’t happen after just one hour reading questionable “authorities” on the topic on the Web.
How do you deal with an amateur researcher? Try to ask them—without sounding snide, which some physicians unfortunately tend to sound like when addressing laymen—what they learned online and where. Explain why their situation is different and why you can make a better evaluation than some authority on the Web who has not yet examined them.
If all else fails, politely suggest that they seek a second opinion. It might help them make up their minds if more than one expert tells them face-to-face what they have to hear.
Basically, the idea is to gently and respectfully remind them of your expertise in the area and outline your reasons for making a particular diagnosis or opinion. The key words here are gently and respectfully. Whacking a patient over the head with your medical school degree isn’t likely to be met with a positive response, after all.
The Forgetful Patient
Forgetful patients are the repeat offenders: the ones who forget appointments or to take their medication regularly. Sometimes, it really is just that the person is careless about such things or has a memory like a sieve. In other cases, it might be due to altered capacity (e.g. those with dementia).
Senile patients will need a designated caretaker to handle things like this for them, of course. For patients who are just naturally forgetful, though, you can make use of current tech to help. EMR software like ours boasts an SMS reminder system for patients to make/keep appointments, for example. These things can be automated to save you time and trouble.
Most patients chat in the exam room. It’s normal, right?
Sure, but if a patient won’t let you get a question in edgewise, it’s fair to say you have a chatterbox on your hands. When patients get so chatty that they get in the way of you discharging your duties even to them, you have to be firmer in your handling.
Let them talk, by all means, but make sure you get your questions and notes in too… even if that means interrupting them every now and then by calling their names firmly. You might have to do it a dozen times in a single check-up, but it’s better than trying to shout them down.
You might also want to ask them if they are worried or nervous about something. Some people are not really chatterboxes by nature. Rather, they become chatty due to an attack of nerves or in order to mask their fear.
Sad to say, some patients do show up for appointments in search of ways to fuel addictions. Usually, these are people seeking pain-killers. The goal is to get the next dose of Oxycodone or Dilaudid.
How do you separate these people from those truly suffering? It’s not a hard and fast science. Some of them you can spot easily, some of them you can’t.
In many cases, they won’t even bother pretending to display the typical outward appearances of pain even while claiming it. They might exaggerate symptom severity in hopes of getting you to act faster. Some might even display zero interest in your diagnosis even as they name specific medications they “know” they need.
Unless you have sufficient medical grounds to deny them the medication, though, there is little to do save to treat their pain as real. If you have a strong enough relationship or rapport with the patient, you can try to talk to them about the problem as well. Some genuinely fail to recognize the signs of addiction in themselves. Others can actually be reached through a properly-ordered intervention.
Ever had a patient who managed to ignore every part of your treatment plan? Or a patient who, even in the face of overwhelming illness, still managed to reject his prescribed meds? You may be facing a noncompliant. These rebels don’t fail to follow instructions because they forget them or can’t afford them: they just don’t follow them.
There are so many possible reasons for this. Sometimes it might be an attempt to reject what is wrong with them, like the patients in denial. At other times, it might even be because they distrust your advice. Some could even be acting out a form of self-destructive/suicidal behavior. Some might even have given up (feel that treatment is futile).
It’s important to talk to patients who act like this so you know their reasons for acting the way they do. Only then can you try to help break them out of this behavior.
Be sure, however, that you ask yourself if you might be part of the issue. It may be a painful question, but it has to be covered. Are you communicating what they need to do in an effective manner? Do they know why they need to do it? Do they fully comprehend the consequences if they don’t?
It’s very rare to find someone who does something without a reason. Before simply getting angry with noncompliant patients and dismissing them out of hand, try to plumb their reasons for being noncompliant in the first place.
The Angry Patient
Angry patients act out for several reasons. They might be in such severe physical distress that this is the only way they can deal with it, for example. It might even be because of some emotional stimuli they received recently. It can also be a sign of psychiatric issues.
Either way, it can be frightening. The angry patient is one of the hardest to deal with, especially when he turns physical. Even one expressing his emotions verbally can be harmful to the atmosphere of a clinic. It can distress other patients and prevent you from focusing on your job.
Every practice should have emergency procedures for dealing with violent patients or intruders. Talk to a security professional about developing some for your practice: who should do what or how, where should other patients be herded, what should be said to de-escalate the situation, and so on.
Above all, make sure everyone on staff knows a code word meant to tip off the rest of the practice that a patient has the prospect to be violent. Make sure to choose a word you that isn’t normally spoken by your staff so no false alarms are given. When someone starts seeing signs of a possible situation, have them work the code word into a conversation with nearby staff members so that everyone nearby can hear it and prepare.
The No-Boundaries Patient
You want your patients friendly, but not too friendly. When a patient starts to do things like flirt with you, for instance, you may want to take a careful step back. This can make things very awkward.
The idea is to establish boundaries clearly with that patient: make it clear that you are there as their healthcare professional, not something else. If that is still a problem for them, you should politely suggest to the patient that he or she may be better off seeing another doctor. Otherwise, the patient may end up interfering with his own care.
Have you had experience dealing with a no-boundaries patient? What about the other scary patient types above?
Share with us and other doctors how you dealt with the situation, whether in the comments below (it’s OK, no one has to use names!) or on Twitter / Facebook. We want to know how our doctors are managing the social challenges of their profession!
PS. You’ll need a clinic management and EMR system to keep track of these patients, so you’ll have some early warnings.