ali shagrawi - dealing with defecult patient.pptx

dealing with defecult patient in psychiatry

1. Difficult Patient BY: Ali Alshaqrawi 9/2/2018 1

2. Warm up Your clinic is running late, your computer has crashed for the third time today, you missed lunch, and then a patient with multiple complex medical problems comes in with a long list of new symptoms. He demands that you prescribe a new drug that is still being tested in clinical trials and refuses to listen to your explanation as to why you cannot do so. Voices become raised, and the consultation reaches a stalemate. How do you resolve this situation? - https://www.bmj.com/content/347/bmj.f4673 9/2/2018 2

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4. Definition: The adjective difficult often refers to the lack of cooperation between patient and care provider. Although the patient seeks help and care , the patient does not readily accept what is offered. - Koekkoek , B., Meijel , B. V., & Hutschemaekers , G. (2006). "Difficult Patients" in Mental Health Care: A Review.  Psychiatric Services,   57 (6), 795-802. doi:10.1176/ps.2006.57.6.795 9/2/2018 4

5. - Koekkoek , B., Meijel , B. V., & Hutschemaekers , G. (2006). "Difficult Patients" in Mental Health Care: A Review.  Psychiatric Services,   57 (6), 795-802. doi:10.1176/ps.2006.57.6.795 9/2/2018 5

6. Theoretical explanations of the difficulty: Individual factors Chronicity Dependency Character pathology Interpersonal factors. (transference and countertransference) - Koekkoek , B., Meijel , B. V., & Hutschemaekers , G. (2006). "Difficult Patients" in Mental Health Care: A Review.  Psychiatric Services,   57 (6), 795-802. doi:10.1176/ps.2006.57.6.795 9/2/2018 6

7. Factors contributed in difficulty: - https://www.aafp.org/fpm/2007/0600/p30.html 9/2/2018 7

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9. Why challenging interactions are bad for everyone?! 9/2/2018 9

10. Difficult interactions with patients can take up a disproportionate amount of a doctor’s time, resources, and emotional energy. They can cause the doctor to feel stress, anxiety, anger, and helplessness, and can even lead to a dislike of the patient and the use of avoidance strategies. This response could compromise the doctor’s ability to give good care and put the doctor at increased risk of making mistakes, which can affect the clinical outcome for the patient. A difficult interaction will leave both the doctor and the patient feeling frustrated and dissatisfied, and can decrease the trust in the doctor-patient relationship. As a result, the patient may be more likely to ask for an appointment with another doctor in the practice for a second opinion, or turn up at the emergency department in hospital, which ultimately leads to higher use of healthcare resources. 9/2/2018 10

11. Dealing with the issue. 9/2/2018 11

12. Verbalize the difficulty.  “elephant in the room”. Consider alternative explanations.  “reframing”. Support the patient. Set boundaries where appropriate. Find some common ground. Focus on finding solutions rather than areas of disagreement. 9/2/2018 12 - https://www.bmj.com/content/347/bmj.f4673

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