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Physician coaching advice: Four simple tips to help you deal with difficult patients

Difficult, belligerent, or entitled patients can be among the greatest challenges for physicians and other health care professionals. Unfortunately these kinds of patients tend to show up when a provider is having a long, trying day. Of course, you try to be patient since responding in kind is not an acceptable approach. However, you are human and it doesn’t feel good to be treated poorly, despite the assumption that you are the provider and are paid to simply absorb whatever comes at you.

As a general rule, healthcare providers are not often taught about how to work with difficult patients and the challenging emotional states that can arise in response – both your own or your patient’s. It can be especially challenging to work with the thoughts that arise when a patient triggers your judgments and disdain. Most of the time, providers either try to bury negative feelings, or if they can’t, they often take the emotional strain out on other people, oneself, or both. Either approach is not sustainable.

When the strain starts to get to you, there are four simple things you can do to help cope. These suggestions are quite simple but are not necessarily easy; nonetheless, with practice and support you can minimize the effect of negative situations:

1) Don’t take criticism personally

Put the patients behavior in the context of their likely feeling vulnerable and out of control of their circumstances. Everyone feels vulnerable once in a while and most people don’t respond particularly well when they are in its grasp. A doctors office can be quite unsettling for many. Remembering this and not personalizing a patient’s challenging behavior can help a lot.

2) Don’t try to push away negative thoughts

It is quite natural to think all kinds of thoughts regardless of how pleasant, unpleasant, socially acceptable or unacceptable those thoughts may be. Thinking the thought itself doesn’t necessarily mean that you have to act on it or that you had anything to do with the thought coming up. It is the nature of the mind to generate all kinds of thoughts including judgment, bias, impatience and disdain. But not personalizing or trying suppress thoughts is key. When you learn how to simply observe thoughts instead of going to war with the unpleasant, or socially unacceptable ones, you can free up enormous energy to focus productively on the work at hand.

3) Be caring, but be clear

Being a health care provider does not mean you agreed to be poorly treated without advocating for yourself. You can say something to your patient in a compassionate manner that does not reprimand, yet makes it clear that you have certain expectations and being treated with respect is one of them. Saying something like, “I realize you aren’t feeling well but try to remember that I am here to support you,” can help the situation enormously. Being compassionate yet clear, respectful and direct can in itself be a form of skilled medical treatment that benefits a patient as much or more as treating their physical symptoms. Relating to a patient, or anyone, in this way, especially when the person is feeling vulnerable, can be a healing act for everyone.

4) Listen for the deeper cause to a patient’s reaction

What if instead of being rude or belligerent your patient is simply disengaged and distant? One doctor who engaged me for physician coaching told of an exchange he had while trying to explain to an elderly patient that the patient had prostrate cancer. The patient did not appear to grasp what he was being told and continued to repeat his questions despite the doctor’s multiple attempts to answer. My client began to feel irritated and impatient, interpreting his patient’s questions as an unnecessary inconvenience. But as he and I discussed the situation, I pointed out that perhaps the patient was feeling overwhelmed and simply couldn’t hear this difficult news as well as the treatment plan at that moment. Perhaps what the patient needed most was a steady, gentle, supportive presence from someone who understood his circumstances, even if the patient did not. Perhaps the patient needed the doctor to just sit in silence for a few minutes and allow the patient to absorb the magnitude of the situation.

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When another situation like this occurred later, my client found that a few minutes just sitting quietly with the patient went a long way. He then scheduled a conversation at a later time to explain the details of the disease and the treatment plan, which ended up being far more productive.

Seeing a patient’s situation in a new light can help you to be less irritable and more compassionate. It can also make you a more effective provider, which in turn not only means better care for the patient, but feeling better about yourself.


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