What makes a difficult patient so <i>difficult</i>? Examining the therapist's experience beyond patient characteristics

Fischer, Candice; Cottin, Marianne; Behn, Alex; Errázuriz, Paula; Valdés-Sánchez, Nelson

doi:10.1002/jclp.22765

Cited by 14 publications

(18 citation statements)

References 33 publications

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“…Patient characteristics that professionals experienced as potentially problematic correspond with the findings in the scientific literature. These characteristics include personality disorders, drug problems/dependency, low intelligence or/and a lacking awareness of their psychiatric condition, a weak or problematic social network, or/and aggressive or threatening behaviour (Fischer et al 2019;Koekkoek et al 2006;Koekkoek et al 2011b;Sellers et al 2012). The care professionals in our study do, however, consider the use of the label 'difficult patient' undesirable, as it stigmatizes and obliterates the influence of other important factors.…”

Section: Discussionmentioning

confidence: 85%

“…These characteristics include personality disorders, drug problems/dependency, low intelligence or/and a lacking awareness of their psychiatric condition, a weak or problematic social network, or/and aggressive or threatening behaviour (Fischer et al . 2019; Koekkoek et al . 2006; Koekkoek et al .…”

Section: Discussionmentioning

confidence: 99%

“…According to Shattell (2004), the use of the label ‘difficult patient’ may cause professionals to distance themselves from the patient. Fischer et al (2019) emphasize that once a patient is labelled as difficult, it is hard to shed this label. Overall, our study suggests the need to focus on a wider range of factors that are relevant for disruptions in care processes.…”

Section: Discussionmentioning

confidence: 99%

“…The negative feelings that professionals may experience, such as frustration and anxiety, in turn contribute to the labelling of a patient as difficult (Fischer et al . 2019). The findings of our study also show that there may be a lack of understanding on the part of the professional of the patient's behaviour.…”

Section: Discussionmentioning

confidence: 99%

“…2013; Fischer et al . 2019). Differing visions and ways of working clash, for example in setting limits.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Dealing with care disruption in High and Intensive Care wards: From difficult patients to difficult situations

Gerritsen

Widdershoven

Ham³

et al. 2020

Int J Mental Health Nurs

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High and Intensive Care is a relatively new care model in Dutch mental health care for clinical admissions. One of the goals is to keep the admission short. For some patients, this goal is not realized, which results in a long‐term admission. Often, this is experienced as a disruption. Disruptions in care processes are frequently defined in terms of patient characteristics. Yet, it may be that other factors play a role. The aim of this study is to gain better insight into the perceptions of care professionals of what is characteristic for disruptions at High and Intensive Care wards and how professionals can deal with these. Qualitative research was performed by means of semi‐structured interviews and a focus group with professionals. Results show that a focus on patient characteristics is too narrow and that other factors also play an important role. These factors include challenges in the relation between professionals and the patient, a divided team, and a lack of collaboration with ambulatory care. In order to deal with these factors, professionals should invest in the relationship with the patient, identify destructive team processes early, and improve communication with ambulatory care. It is recommended to develop a monitoring tool that includes all these factors. Another recommendation is to organize structured reflection on dilemmas experienced in care. In conclusion, this study shows the importance of going beyond patient characteristics in order to better understand, identify, and deal with disruption at High and Intensive Care wards.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…2013; Fischer et al . 2019). Differing visions and ways of working clash, for example in setting limits.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Dealing with care disruption in High and Intensive Care wards: From difficult patients to difficult situations

Gerritsen

Widdershoven

Ham³

et al. 2020

Int J Mental Health Nurs

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Complex Depression in High-Pressure Care Settings: Strategies and Therapeutic Competences

Parra

Zúñiga

Dagnino

et al. 2021

Depression and Personality Dysfunction

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Tough Clinical Decisions: Experiences of Polish Physicians

et al. 2022

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The paper reports results of the very first survey-based study on the prevalence, frequency and nature of ethical or other non-medical difficulties faced by Polish physicians in their everyday clinical practice. The study involved 521 physicians of various medical specialties, practicing mainly in inpatient healthcare. The study showed that the majority of Polish physicians encounter ethical and other non-medical difficulties in making clinical decisions. However, they confront such difficulties less frequently than their foreign peers. Moreover, Polish doctors indicate different circumstances as a source of the experienced problems. The difficulties most often reported relate to (i) patients (or their proxies) requests for medically non-indicated interventions; (ii) problems with communication with patients (or their proxies) due to the patients’ negative attitude, unwillingness to cooperate, or aggression; and (iii) various difficulties with obtaining informed consent. Polish physicians report difficulties associated with disagreements among care givers or scarcity of resources less frequently than doctors from other countries. The study’s findings provide support for the thesis that a significant portion of Polish physicians still follow a traditional, paternalistic, and hierarchical model of healthcare practice. Instead of promoting patient’s empowerment, engagement, and rights, they often consider these ideas as a threat to physicians’ professional authority and autonomy. The study leads to the conclusion that due to insufficient training in medical ethics, communication skills, and medical law, many Polish physicians lack the knowledge and competence necessary to adequately respond to challenges posed by modern healthcare practice.

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What makes a difficult patient so difficult? Examining the therapist's experience beyond patient characteristics

Cited by 14 publications

References 33 publications

Dealing with care disruption in High and Intensive Care wards: From difficult patients to difficult situations

Dealing with care disruption in High and Intensive Care wards: From difficult patients to difficult situations

Complex Depression in High-Pressure Care Settings: Strategies and Therapeutic Competences

Tough Clinical Decisions: Experiences of Polish Physicians

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