Although managing difficult or frustrating patients requires experience, clinicians can enhance their professional lives and job satisfaction while also improving patient outcomes by identifying common causes of challenging behavior and implementing effective strategies.
Dr. Folajimi Senjobi, a family medicine specialist at University College Hospital, Ibadan, made this assertion during the Oyo State Nigerian Medical Association (NMA) September continuing medical education series titled *Management of Difficult and Angry Patients*.
According to Dr. Senjobi, 15 to 20 percent of patients receiving medical care are thought to be difficult. However, the term “difficult patient” refers more to the doctor’s response than to specific criteria of difficulty and does not denote a distinct diagnostic category.
He explained that typical difficult patient behaviors include drug-seeking, violent, litigious, seductive, angry, non-paying, manipulative, needy, argumentative, and persistently complaining traits. For example:
– **Entitled demanders** are inexhaustibly needy and, instead of expressing gratitude or using flattery, resort to intimidation, devaluation, and guilt toward the doctor managing their care.
– **Dependent clingers** are excessively reliant on the doctor, desperate for reassurance, and repeatedly return with a new array of symptoms.
– **Manipulative health rejectors** repeatedly return to the clinic, claiming that treatment has failed.
Dr. Senjobi further noted that a considerable number of patients labeled as difficult may actually meet the DSM criteria for mood disorders, anxiety disorders, and/or borderline personality disorder. Others include patients dependent on prescription drugs, those with substance abuse issues, and frequent doctor shoppers.
He also highlighted factors influencing difficult patient encounters, including:
– Physicians’ poor communication skills
– Low job satisfaction
– Time pressure during consultations
– Physicians’ personal biases
– Changes in healthcare financing policies
– Past incidents of medical errors or mistrust
– Patients’ personality types
– Unmet patient expectations
– Language and literacy barriers
– Medical uncertainty
– Physical, mental, and emotional abuse
According to Dr. Senjobi, the treatment of a difficult or frustrating patient should be based on a careful and thorough assessment of their physical condition. He warned that strategies such as ignoring the problem, accusing the patient of being difficult, attempting to solve the issue solely with psychopharmacology, or telling the patient that nothing is wrong will be counterproductive.
Instead, he recommended adopting the patient-centered clinical method of care, which explores patient problems and guides the best approach for defining and deciding on the management plan for both the disease and the illness experience, in collaboration with the patient.
Chairman of the Association of Medical Doctors of Oyo State, Dr. Muyiwa Ajanaku, described the presentation as timely and relevant, stating that it equips medical professionals with practical strategies to handle challenging patient interactions with professionalism, empathy, and patience. He added that while medical knowledge is indispensable, communication skills and emotional intelligence are equally critical tools in clinical practice.
Dr. Akin Sodipo, chairman of the lecture, emphasized the importance of thorough documentation of medical cases due to increasing litigation and demands on medical practitioners in this era.
In his remarks, Dr. Happy Adedapo, the NMA chairman, urged health practitioners to master the skill of handling difficult or frustrating patients to improve healthcare delivery.
https://tribuneonlineng.com/difficult-patients-common-but-not-a-distinct-diagnosis-of-ill-health-expert-says/