3 1. Dependent clinger Express excessive gratitude for doctor’s actions Seek regular reassurance over minor problems
4 2. Entitled demanderFrequently complains about imagined shortcomings in service
5 3. Manipulative help rejector Presents a series of symptoms doctor is powerless to improve
6 4. Self destructive denier Patient refuses to accept his behaviour affecting his diseaseWill not modify self-harming habit
7 Difficult relationship An approach to theDifficult relationship
8 Acknowledge 1. Engagement Review Whether you ‘engaged’ properly with the patient at the beginning of consultation
9 Acknowledge2. EmpathyMake sure the patient knows he or she has been seen, heard and understood
10 Acknowledge 3. Education Provide patient with enough information to understand what you are advising
11 Acknowledge4. EnlistedMotivate patient to accept your advice
12 Rebuild relationship1. Shave the relationship difficulty by verbalising ite.g. “ I’m finding it difficult to help youbecause…….”
13 Rebuild relationship 2. Build a partnership e.g. “ How do you feel about that? Can youthink of ways you can help me helpyou? Is there something I can do tohelp us work together better? ”
14 Boundaries1. Define you boundaries and seek patient’s acknowledgement and agreement to theme.g. “ Mrs. Smith, I’ve made a list of the eight things.You’re asked me to deal with today, but you didnot book a long consultation. I think we can dealwith three today in the time we have, would youlike to say which three you’d like me to deal withtoday and which can be deferred to tomorrow? “
15 Boundaries2. TemporalHow much time you are prepared to give.
16 Compassion1. EmpathyAcknowledge the patient’s education and make sure he or she knows you see
17 Determine the meaning People do things for a reason Every patient comes with a pre-set belief about what could be the problem and what might be the solutionFind out what they are thinking
19 1. Miss Wong, aged 20, is living with her son (4 years old). She has no remarkable pastmedical history. She works in a karaoke bar. She requests some tests on her liver as her ex-boyfriend died of “liver disease” recently.How would you conduct this consultation?
20 2. Mrs. Chan is now aged 49. She divorced his husband 4 years ago. She recently heard about hormonal replacement therapy in the media and requested this treatment from you. After physical examination and investigation, you found she was fit for HRT. Six months later, Mrs. Chan was admitted into hospital with myocardial infarction. Shortly afterwards her son Paul came to see you. He alleged that the HRT caused her mother’s heart attack.How would you interview with him.
21 3. Mr. Wong, aged 45 and a construction site labourer, complained of persistent low back pain for 2 months. He alleged this to a fall at work 3 months ago when he was hit by a pile of stacked timber. He was pursuing compensation for negligence against his employers. He had no abnormal physical signs and X-rays of his lumber spine have been normal. He denied any unhappiness and worries apart from the unbearable pain at work. He has consulted other doctors without relief. He then requested a sick leave certificate for a month as he did not think he can work, and no treatment other than rest could help him.
22 3. What would you do?Knowing that you are not going to give him a long sick leave, Mr. Wong bursts into foul languages and wares his arm in front of you while demanding his request again.What do you do next?
24 What is angerA person’s emotional response to provocation of to a threat to his or her equilibriumManifestation of a deeper fear and hidden insecurity
25 Guidelines for handling angry patient DoListenBe calm : keep still and establish eye contactAsk patient to sit downAddress patientBe comfortableShow interest and concernUse clear and firm languageBe sincereAllow patient to ventilate feelingsArrange follow up
26 Guidelines for handling angry patient Don’tTouch the patientMeet anger with angerReject the patientBe over familiarTalk too muchBe judgmental
27 Questions in the interview Rapport building‘ I can appreciate how you feel ‘‘ it concerns me that you feel so stronglyabout this ‘‘ tell me how I can make it easier for you ‘
28 Questions in the interview Confrontation‘ you seem very angry ‘‘ it’s unlike you to be like this ‘‘ I get the feeling that you are upset with …’‘ what is it that is upsetting you? ‘
29 Questions in the interview Facilitation , Clarification‘ so you feel that………. ‘‘ you seem to be telling me…….. ‘‘ if I understand you correctly……….. ‘‘ tell me more about this…………. ‘
30 Questions in the interview Searching‘ do you have any special concerns aboutyour health? ‘‘ do you relate to anyone who has a problemlike yours? ‘