A recent encounter with a patient began with a hushed warning from the administrative staff that this patient was difficult. I entered the room with some trepidation, the resolve to maintain my composure whatever happened, and the faint hope that I may be able to win the patient’s trust. He spent significant time in that initial encounter describing in strongly negative terms the care he had received from a prosthetist who was no longer with the company. Details in the clinical record were limited, but it appeared that some of the patient’s complaints were valid. It was also clear that his primary complaints related to the way the prosthetist had behaved toward him. He had been satisfied with care he’d received from a second prosthetist whose recent retirement added to the patient’s frustration. His animosity toward the first prosthetist had not waned in the many months since those original encounters, and communicating this was clearly his top priority.
Several aspects of the patient’s personality, mannerisms, and behaviors raised questions about his credibility. While many of his complaints related to the poor prosthetic care he believed he had received, he also spent considerable time reporting problems that are commonly associated with initial prosthetic fitting. When his diatribes expanded to include politics and retail customer service, I began to suspect that a generally negative worldview was at the root of his complaints. He reported a high view of his own intellect and abilities that I found inconsistent with his general demeanor and self-care habits. Resisting the urge to dismiss his complaints or correct his perceptions, I chose instead to listen and acknowledge his frustration. (It was relatively easy to not react defensively, since his complaints were not about me or care I had provided.) Those efforts paid off during subsequent encounters. Sufficient trust had developed that when I suggested focusing on current prosthetic problems he responded positively.
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