Taking Care of the Hateful Patient

Abstract

"Hateful patients" are not those with whom the physician has an occasional personality clash. As defined here they are those whom most physicians dread. The insatiable dependence of "hateful patients" leads to behaviors that group them into four stereotypes: dependent clingers, entitled demanders, manipulative help-rejecters and self-destructive deniers. The physician' negative reactions constitute important clinical data that should facilitate better understanding and more appropriate psychological management for each. Clingers evoke aversion; their care requires limits on expectations for an intense doctor-patient relationship. Demanders evoke a wish to counterattack; such patients need to have their feelings of total entitlement rechanneled into a partnership that acknowledges their entitlement--not to unrealistic demands but to good medical care. Help-rejecters evoke depression; "sharing" their pessimism diminishes their notion that losing the symptom implies losing the doctor. Self-destructive deniers evoke feeling of malice; their management requires the physician to lower Faustian expectations of delivering perfect care.

What's ‘difficult’? A multi-stage qualitative analysis of secondary care specialists' experiences with medically unexplained symptoms

“…In this regard, we think it is important to encourage doctors to recognize their own emotions and legitimise their 'difficult' experiences [42]. A productive way of doing this might be to reflectively use the doctors' emotional reaction as an indicator for where the patient's problems might lie and thus facilitate better understanding and more appropriate psychological management [69], [28]. Greater awareness of their own emotional reaction might in turn lead to greater awareness for patients' emotional distress which doctors, as Henningsen et al describe it, tend to 'somatise' -i.e.…”

Courage and Compassion: Virtues in Caring for So-Called “Difficult” Patients

“…Groves [2] attempts to categorize "difficult" patients into four types: clingers (needy patients who evoke aversion and need clear boundaries), demanders (entitled patients who use intimidation, devaluation, and guilt to get what they want), help-rejecters (pessimistic, needy, nothing-works patients who evoke selfdoubt), and self-destructive deniers (who display self-destructive behavior, ignore recommendations, and evoke strong negative feelings). Any student or clinician who has been in practice can recognize, and likely conjure particular memories of, patients who fit these categories.…”

“…In his 1978 article, "Taking Care of the Hateful Patient" [2], James E. Groves wrote about "those [patients] whom most physicians dread" [3]-patients who, as others have noted, seem to display "behavioral or emotional aspects" such as "psychiatric disorders, personality disorders, and subclinical behavior traits" that, while not necessarily related to their primary medical condition, nonetheless complicate their care [4]. What, if anything, can medical ethics offer to assist in the care of such patients?…”

Forty Years since “Taking Care of the Hateful Patient”

“…In his 1978 article, "Taking Care of the Hateful Patient" [1], James E. Groves argues that patients who fill clinicians with dread can be assigned to categories that include "clingers," "demanders," "help-rejecters," and "self-destructive deniers," and that these same categories can provide guidance to clinicians interested in managing their care more effectively. Groves's article inspired further research on not only the characteristics of so-called "difficult" patients but also factors that can contribute to patients being perceived as difficult and strategies clinicians can use to respond appropriately to these patients' needs [2].…”