The Art of Treating Challenging Patients: An Interview With Karen Broquet, MD
Some research suggests that as many as 15% of adult patient encounters can be described as “difficult.”1,2 Handling these situations requires skill and empathy. To shed further light on navigating this challenging terrain, MPR interviewed Karen Broquet, MD, MHPE, Associate Dean for Graduate Medical Education and Professor, Departments of Internal Medicine and Psychiatry, Southern Illinois University School of Medicine, Springfield.
What motivated you to focus on this issue?
I have colleagues who have been so distressed when they encountered negative feelings toward patients in themselves that they have sought advice from me. It is clear that there is a need for education in this area. In 2007, I coauthored an article with Sharon Hull, MD,3 about difficult patient encounters and my coauthor and I continue to get calls from caregivers about these issues.
What do you mean when you talk about “difficult patients?”
The broad term “difficult patient” actually encompasses two major categories: patients who are hard to deal with and “push our buttons,” but do not threaten our physical safety, and patients who are potentially violent.
Speaking to the first category, what types of patients can generate negative feelings in healthcare professionals?
An important starting point is to recognize that we cannot meet patients' needs all of the time. While this may be self evident to us, it is less so to patients. So one common scenario is the patient who has expectations that we cannot meet and becomes angry, demanding that we be available after hours or taking up unnecessary time during appointments. In situations like these, it is the job of the physician to set clear and consistent limits and recognize that these limits are not only to protect ourselves but also to serve the patient. Our confidence that we are acting with the patient's best interests at heart will be helpful in providing this framework.
Are there other reasons for anger in patients?
A patient might be angry about factors that have nothing to do with the physician but the anger ends up being directed at the physician—perhaps some hospital policy or circumstance in the patient's life. It is natural to become defensive or overly solicitous and try to placate the patient. Neither approach works well.
Instead, begin with finding out why the patient is angry. Listen with empathy and respect as the patient is expressing reason for the anger and acknowledge the patient's feelings. “I understand why you feel this way, it is difficult dealing with these policies.” And apologize if the patient has been inconvenienced, even if you were not actually at fault. “I'm sorry you were kept waiting for so long and I appreciate that you waited for me.” This can help to ease the patient's frustration.
Some patients become angry if they receive a grim diagnosis or if a family member has had unexpected complications or died. In their grief, they may look to blame the physician. Recognizing the origin of the anger will go a long way to providing empathy and support.