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Dysfunctional Consultations c/o Dr Ramesh Mehay www.bradfordvts.co.uk.

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Presentation on theme: "Dysfunctional Consultations c/o Dr Ramesh Mehay www.bradfordvts.co.uk."— Presentation transcript:

1 Dysfunctional Consultations c/o Dr Ramesh Mehay www.bradfordvts.co.uk

2 Aims Recognition of different types of difficult patients Whose problem is it? Why are they so important? How to deal with them

3 Objectives SESSION 1 Define a dysfunctional consultation? Define a difficult patient? Is it a problem in the patient or the doctor? Coffee SESSION 2 Groves Classification of difficult patients Specific Methods of dealing with them

4 SESSION 1 LET’S THINK ABOUT THEM Who are they and How do I recognise them?

5 What is a dysfunctional consultation? “An exhausting consultation between a doctor and a patient which often triggers off some powerful negative emotions either in the doctor dealing with them, in the patient or both!

6 Brainstorming Session Working in pairs make a list of difficult types of patients you have encountered.

7 Brainstorming Session Now working in groups of four share your lists and aggregate them into common groups

8 How common are they? EVERY GP has them and so will you!

9 What’s all the Fuss? Doctor Reasons Stress, fear, anger, low morale, helplessness Patient Reasons unnecessary Ix & Rx Society Reasons Expensive!

10 Whose Problem is it Anyway? The patient The doctor The Dr – Pt relationship patient doctor

11 Is it the Patient – list of features Female > male Age > 40 Single, divorced or widowed (isolation) personal (marital, family) problems Co-existing depression

12 Is it the doctor? Different people have different personalities and characteristics Mathers et al (1996) Sheffield Survey of GP’s 65% variance amongst GP’s in their selection of heart sink patients You can please SOME people ALL of the time BUT You can never please ALL of the people ALL of the time

13 Is it the Doctor? Insecure Doctors Competitive Doctors Over caring Doctors Hard line Angry Doctors Doctors of Perfection Normal Doctors – Yes You!!!!

14 Is it the Dr-Pt Relationship? Flipchart patient doctor 1. Unidirectional Consultations Leading to Failing to understand patients ICE Failing to appreciate affect on patients life Failing to appreciate patients coping mechanism 3. Certain Medical Illnessses - Christie & Hofmaster (1986) 2. Patient behaviour that annoys the doctor – Christie & Hofmaster (1986) “Pull Yourself Together” report (2000), Mental Health Foundation)

15 How Can You Spot Them? Working in pairs – think how you might recognise them in practice? Think in these broad areas: Patient characteristics Patient beliefs The types and nature of consultations

16 SESSION 2 The Meaty Bit! How do I deal with them?

17 Groves In 1951 he described hateful patients! His four categories are just as applicable now! 1.The dependant clinger 2.The entitled demander 3.The manipulative help rejector 4.The self destructive denier 5.The malodorous minger (oops!...sorry, that’s one of mine!)

18 Why GP’s Don’t Like Them Negative emotions ranging from hopelessness to anger Diagnostic difficulties and the ‘devil of uncertainty’ Time (often long multiple appointments) Cost (emotional cost to you and the financial cost to the Practice and the NHS)

19 Why is it important to have a management plan? Working in pairs list the reasons Then in groups of four think about the ways in which you can manage these four types of heartsinks; dependant clinger, entitled demander, manipulative help rejector and the self destructive denier Now form into 4 groups each taking one of the different classes, formulate and then present your plan

20 Why Is it Important to Have a Management Strategy For them? Prevent chronic sick role Reduce doctor dependency Avoid doctor shopping Maintain the doctor-patient relationship some how To make the doctor feel comfortable in dealing with them (exterminate negative emotions) To avoid missing a true illness

21 RULES FOR ALL OF THEM 1 Recognise own feelings Build rapport Encourage more patient responsibility Firm structured consistent approach Keep in control Frequent attenders – boundaries/limits, hierarchical problem list, share the workload, delayed response “Whose problem is it?” House keep yourself

22 Managing them (other solutions) Boundaries & Limits Share the workload Delayed Response Avoid difficult situations


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