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‘It is the patients who have the problems while doctors have the difficulties.’ Four of the more common types of difficult ‘heartsink’ patients are: dependent clingers, entitled demanders, manipulative help rejectors and self-destructive deniers.
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Adhere to the principles of good communication and consulting skills, esp. the art of listening, rapport building, diplomatic confrontation, facilitation and searching. Seek the reason for the behaviour and become familiar with the characteristics of personality disorders (
397), esp. the antisocial (sociopathic) group (e.g. histrionic, borderline, narcissistic ‘prima donna’).
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Guidelines for handling the angry patient
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Do: listen, be calm and comfortable, be conciliatory and genuine, show interest and concern, be sincere, give time, allay any guilt, arrange follow-up, be a friend in need.
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Don’t: meet anger with anger, touch the patient, reject the patient, be evasive or a ‘wimp’, be overfamiliar, judgmental or patronising, talk too much.
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Five-step approach for drug-dependent ‘shopper’
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Elicit request for drug early: ‘What did you have in mind?’
Respectful refusal and brief minimal explanation: ‘I don’t prescribe x. I could but I choose not to.’
Avoid being drawn into the patient’s agenda.
Depersonalise: ‘It’s not you personally—it’s the way I work.’
Offer alternative help.