Content uploaded by Christopher Pearce
Author content
All content in this area was uploaded by Christopher Pearce on Sep 26, 2014
Content may be subject to copyright.
The difficult patient
Abstract
A large percentage of any general practitioner's time is taken up by a small number of patients, the 'difficult' patient. These patients often have chronic, painful problems, and are unresponsive to traditional medical methods. By understanding the concepts of the patient centred clinical method, and looking beyond the traditional biological model of disease, an approach to these patients can be developed that is simple and enduring.
... It also includes discussion and reflection on the patients' expectations on care and treatment of diabetes. Different types of patients' characteristics, such as 'the difficult patient' (Pearce 2002;Macdonald 2003), and different 'working relationships' between patients and professionals are also elaborated. Supervisor, nurses and physicians bring up this discussion frequently. ...
The aim of this research was to explore the role of a professional development supervisor in helping health professionals to reflect on their role in patient consultations. This article is written from the viewpoint of patient-centred care and seeks to examine how the mentor/supervisor can facilitate reflection and learning by discussing, with professionals, videotapes of their regular meetings with patients. The specific context of the article is an educational intervention in Sweden, based on modern theories of competence development for professionals in diabetes care. A purposeful sample of 18 patients with type 2 diabetes agreed to have their regular meeting with a general practitioner (GP) or diabetes nurse videotaped. The GPs or diabetes nurses of these patients then participated in an intervention, comprising sessions when they reviewed with a supervisor their consultations with the patients. These supervising sessions were videotaped and are investigated in this article. The supervisor's role was to make observations that could alter the professional's understanding of the diabetes consultation through video-cued narrative reflection. Five overarching themes were identified from the content (the what-aspect) of the intervention: medical problems; patient characteristics and reactions; patient education; the consultation as such; and the healthcare organization. The activities used in carrying out the intervention (the how-aspect) were: confirmation and feedback; interpretation; reflective questioning; suggestions and corrections; and closed-end questions or brief answers. It was hypothesized that this way of conducting reflective educational interventions would be beneficial for healthcare professionals when working with patients with various longstanding medical conditions, recognizing that a patient-centred approach which included the patient's learning and possibilities for self-management are more suitable for the chronic illness encounter.
... This work was based on inpatient consultations done in the general hospital, and described approaches to these patients founded in a psychological understanding of the patient's coping and personality style. A further review of the literature suggests a series of communication strategies to work with the difficult patient in a more effective way to improve the doctor-patient interaction (Kissane, 1994;Pearce, 2002;Essary & Symington, 2005) One contemporary view is that anger can represent dysfunction in the doctor-patient relationship, and it is important for physicians to be observant of their participation in the interaction and adjust their behavior and communication accordingly (Lown, 2007). ...
The purpose of this study was to develop a communication skills training (CST) module for oncology healthcare professionals on how to more effectively respond to patient anger. We also sought to evaluate the module in terms of participant self-efficacy and satisfaction.
The development of this module was based on a systematic review of the literature and followed the Comskil model previously used for other doctor-patient CST. Using an anonymous 5-point Likert scale, participants rated their pre-post self-efficacy in responding to patient anger as well as their satisfaction with the course. Data were analyzed using a paired sample t test.
During the academic years 2006-2009, 275 oncology healthcare professionals participated in a CST that focused on responding to patient anger. Participants' confidence in responding to patient anger increased significantly (p < 0.001) after attending the workshop. They also agreed or strongly agreed to five out of six items assessing course satisfaction 92-97% of the time.
We have developed a CST module on how to respond to patient anger, which is both effective and useful. Training healthcare professionals to respond more effectively to patient anger may have a positive impact on the patient-physician relationship.
Eine gute Arzt-Patient-Kommunikation hat positive Auswirkungen auf die Zufriedenheit, Compliance und den Gesundheitszustand von Patienten und kann Ängste reduzieren und zu einem besseren Erinnerungsvermögen und Verständnis der vermittelten Informationen auf Patientenseite führen. Im Verlauf der Diagnostik und Erkrankung erleben Patienten sowie Angehörige verschiedene Stimmungs- und Emotionswechsel. Dazu gehören Traurigkeit, Sorgen, Frustration und Ärger, aber auch Unsicherheit und Angst vor dem Fortschreiten der Erkrankung, interpersonelle Schwierigkeiten, Rollenkonfusion sowie Unsicherheiten zum Körperbild. Verschiedene Erwartungen an den Kontakt zwischen Arzt und Patient durch Rollen und Glaubenssätze, das grundlegende Verständnis von Krankheit und Gesundheit, der kulturelle Hintergrund und andere Parameter, die nicht zwingend mit medizinischen Fragen assoziiert sein müssen, beeinflussen das ärztliche Gespräch. Zu den von professionellen Behandlern häufig als schwierig erlebten Gesprächssituationen zählen der Umgang mit Ärger und anderen schwierigen Emotionen, das Gespräch mit der Familie oder das Gespräch via Dolmetscher. Der vorliegende Beitrag gibt einen Überblick über schwierige Situationen in der Arzt-Patient-Kommunikation und illustriert grundlegende kommunikative Fertigkeiten im Umgang mit schwierigen Gesprächssituationen.
Good doctor-patient communication has a positive impact on patient satisfaction, adherence to treatment, health outcomes and well-being, and it has been linked to reduced anxiety, increased recall, and improved understanding. During the diagnostic phase and the course of the illness, patients exhibit a range of mood changes. These include sadness and worry, frustration and anger, uncertainty, fear of disease recurrence, difficulties in inter-personal relationships, changing roles, and concerns about body image. Medical consultations can be influenced by different expectations concerning the doctor-patient interaction, by individual roles and beliefs, and by a different understanding of health and well-being influenced by cultural and other factors not necessarily associated with the medical situation. Responding to anger and other difficult emotions, dealing with family meetings, or communicating via interpreters are often experienced as demanding situations by health care professionals. This article provides an overview of the difficult doctor-patient interactions and illustrates basic communication skills in responding to challenging situations.
Consultant physicians encounter patients, and families and carers of patients, who leave us feeling helpless, frustrated, irritated and even angry. There are limited opportunities for trainees and physicians to discuss how to recognize, manage, learn from and prevent these difficult physician-patient encounters. This paper addresses factors, including physician factors, that may contribute to making encounters difficult, categorizes the types of difficult encounters and provides generic and specific suggestions (based in part on published literature and in part on our personal experience) about prevention and management of many of them.
ResearchGate has not been able to resolve any references for this publication.