Presentation on theme: "Groves (1951) Defined 4 categories of difficult patient."— Presentation transcript:
Groves (1951) Defined 4 categories of difficult patient
1. Dependent clinger Express excessive gratitude for doctors actions Seek regular reassurance over minor problems
2. Entitled demander Frequently complains about imagined shortcomings in service
3. Manipulative help rejector Presents a series of symptoms doctor is powerless to improve
4. Self destructive denier Patient refuses to accept his behaviour affecting his disease Will not modify self-harming habit
An approach to the Difficult relationship
Acknowledge 1. Engagement Review Whether you engaged properly with the patient at the beginning of consultation
Acknowledge 2. Empathy Make sure the patient knows he or she has been seen, heard and understood
Acknowledge 3. Education Provide patient with enough information to understand what you are advising
Acknowledge 4. Enlisted Motivate patient to accept your advice
Rebuild relationship 1. Shave the relationship difficulty by verbalising it e.g. Im finding it difficult to help you because…….
Rebuild relationship 2. Build a partnership e.g. How do you feel about that? Can you think of ways you can help me help you? Is there something I can do to help us work together better?
Boundaries 1. Define you boundaries and seek patients acknowledgement and agreement to them e.g. Mrs. Smith, Ive made a list of the eight things. Youre asked me to deal with today, but you did not book a long consultation. I think we can deal with three today in the time we have, would you like to say which three youd like me to deal with today and which can be deferred to tomorrow?
Boundaries 2. Temporal How much time you are prepared to give.
Compassion 1. Empathy Acknowledge the patients education and make sure he or she knows you see
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 solution Find out what they are thinking
1. Miss Wong, aged 20, is living with her son (4 years old). She has no remarkable past medical 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?
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 mothers heart attack. How would you interview with him.
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.
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?
What is anger A persons emotional response to provocation of to a threat to his or her equilibrium Manifestation of a deeper fear and hidden insecurity
Guidelines for handling angry patient Do Listen Be calm : keep still and establish eye contact Ask patient to sit down Address patient Be comfortable Show interest and concern Use clear and firm language Be sincere Allow patient to ventilate feelings Arrange follow up
Guidelines for handling angry patient Dont Touch the patient Meet anger with anger Reject the patient Be over familiar Talk too much Be judgmental
Questions in the interview Rapport building I can appreciate how you feel it concerns me that you feel so strongly about this tell me how I can make it easier for you
Questions in the interview Confrontation you seem very angry its unlike you to be like this I get the feeling that you are upset with … what is it that is upsetting you?
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………….
Questions in the interview Searching do you have any special concerns about your health? do you relate to anyone who has a problem like yours?