“The label tells us how the encounter feels. It tells us very little about the patient,” Devina Wadhwa, MD, writes in the MedPage Today Perspective column. “When we describe a patient as difficult, we often stop asking questions.”
Neither Brinkmann nor Wadhwa discounts the fact that a proportion of any patient group can be challenging to work with.
“Some patients arrive angry. Some reject recommendations. Some return repeatedly without improvement. Some challenge every suggestion,” Wadhwa writes. “Some direct their frustration at the very people trying to help them. These encounters can be exhausting, particularly in healthcare systems already strained by limited time, limited resources, and growing demands on clinicians.”
The authors each call for an ongoing awareness of the patient’s circumstances, including the dynamic between them, their clinicians, and the healthcare system as a whole.
“We may consider the ideal patient to be one who is mature, responsible, professional, respectful, considerate, and grateful. All these traits are challenged when health fails,” Brinkmann writes.
“In addition to the acute condition that requires [O&P] care, most of our patients have multiple chronic diseases and comorbidities as well as challenging life situations, all of which drain their psychological, social, and financial resources. If the rate of mental illness and other psychosocial diagnoses among our patients was only at the level found in the general population, this would represent a substantial challenge. The reality is that these diagnoses are more common among certain populations who require our care.”
As part of a patient’s life situation, “Anger may be protecting fear. Irritability may be masking grief. Distrust may reflect years of feeling dismissed. Repeated visits may stem from a need that has not yet been identified. What appears resistant on the surface may actually be a person struggling to feel heard,” Wadhwa writes.
“This does not mean every behavior is acceptable…. But understanding behavior and excusing behavior are not the same thing.”
Her concern is that labeling a patient as difficult makes the patient solely responsible for it, instead of a varying “combination of unmet needs, communication breakdowns, competing expectations, systemic barriers, and human limitations on both sides of the conversation.
“More often, I see patients carrying burdens I do not yet fully understand and clinicians trying to care for them within imperfect systems.”
To read “We’ve All Had ‘Difficult’ Patients. But Do They Really Exist?” visit MedPage Today.
To read “Difficult Patients, Practitioners, and Encounters,” visit The O&P EDGE.
