Attitudes and behaviors of physicians in dealing with difficult patientsand relatives: a cross-sectional study in two training and research hospitals

Abstract

IntroductionCommunication skills and problem-solving skills as well as the educational background, knowledge, and experience of doctors are important for establishing effective communication (1-4). Doctors with good communication skills can conceive the problems of patients more accurately, can provide more compliance and satisfaction of patients with treatment, and can reduce stress while improving their professional work satisfaction (4-7). When communication between physicians and patients is considered from this angle, the features and effectiveness of the communication become more important for maintaining a healthy interaction.Difficult situations in which communication is disrupted or broken during physician-patient interviews may occur. During their daily practice, doctors encounter patients described as "difficult" who leave them in difficult situations, frustrate them, and make them feel helpless and inadequate (8,9). For example, it is estimated that difficult patients constitute 15%-30% of examinations performed by family physicians (8,10). The difficulties in patient-physician communication seem to be affected by many factors stemming from the interactions between physicians, patients, situational factors, and the health care system (11). In the literature, the definition of difficult patient includes patient groups such as female patients, patients of low socioeconomic status, and patients who need excessive medical care such as those with psychosocial problems and substance abuse, with multiple medical complaints, and those feeling constantly ill, exhibiting drug-seeking behavior, and with chronic pain (10,(12)(13)(14)(15). Physicians have to allocate a lot more time and energy for these patients to recognize and solve their problems (15). Sometimes, physicians may perceive a Background/aim: The aim of this study was to examine the reasons constituting the definition of 'difficult patient' and to evaluate attitudes and behaviors of physicians in coping with these patients and their relatives. Materials and methods:This cross-sectional study was conducted in May and June 2013 with 400 randomly selected physicians from different specialties working in two training and research hospitals in Ankara. A questionnaire was created by reviewing the relevant literature, by family medicine clinic, and delivered to the physicians following a pilot study.Results: In our study 92.8% of the physicians participating had experienced a negative contact with patients and/or their relatives, previously; 46.8% of the participants stated that they used their own experiences in coping with those situations. The frequency of negative communications was higher in surgical departments, increasing with average daily working hours and number of patients and decreasing with the experience of the physicians. The ways of coping with a difficult patient were nonjudgmental listening, patience, tolerance, and empathy, in declining order of importance. Conclusion:Physicians frequently experience negative communications with patients...

An Evidence-based, Longitudinal Curriculum for Resident Physician Wellness: The 2017 Resident Wellness Consensus Summit

“…Such preparation often leads to better patient care and less physician burnout. 7 In the same way that a difficult patient can lead to decreased physician happiness and satisfaction, so can a bad interaction with a consultant or staff member. This module focuses on practical strategies to keep these encounters professional, positive, and effective.…”

“…Individual curricular initiatives were categorized by theme. 1 – 3 , 5 – 7 , 9 – 23 These themes informed the initial framework of 10 core topics for the curriculum. For each topic, a sub-team conducted a deeper analysis before providing a description of the module, recommended approach, and additional resources and recommended readings.…”

Behaviours of healthcare professionals towards difficult patients: A structural equation modelling study

“…For this reason, it was predicted that the behaviours of healthcare professionals could be addressed in three sub-groups as supportive, negative and ethical and 33 items were generated to assess the behaviours. 5,6,8 –17,21,22 The initial item pool of 33 items was evaluated by seven experts. Experts were physician and nurse educators.…”

“…7 In the studies of physicians that investigated the features of difficult patients, it has been seen that patients with inappropriate demands, high levels of anxiety, multiple repetitive complaints or chronic diseases, and behaviours such as aggression, pessimism, nonadherence to treatment or care, verbally abusive, manipulative, lying, offensive or prone to violence, are perceived as ‘difficult’. 8,9 According to physicians’ viewpoints, groups of difficult patients include patients with multiple physical symptoms and functional disability and using healthcare services excessively. 1,10…”

“…The expected approach was to behave patients without prejudice, approach with patience about difficult encounters and empathise with patients and their families. 9 A limited number of studies exploring behaviours of healthcare professionals for difficult patients have been found in the literature. Especially in Turkey, there is no available study exploring the behaviours of all healthcare professionals towards difficult patients.…”