How to Cope with Difficult Patients
Posted: March 11, 2015 by Cathy Weselby in Reference Desk
Most of the time the patients you care for are grateful and appreciative of all that you do. But it’s not always roses and sunshine. Some patients are demanding, combative and downright rude, and unfortunately dealing with these difficult patients is part of the job.
Patients may act out for a number of reasons. Most people don’t want to be in the hospital in the first place, and they don’t feel well. As a result, they are probably feeling stressed, anxious or depressed, and these feelings can be presented in “difficult” behaviors. It could also be something as basic as a misunderstanding due to language or cultural differences.
Once you learn to identify what’s really going on with a patient, you can tap into your superpowers (otherwise known as communication techniques) to win over even the most disgruntled patient.
Types of difficult patients
A difficult patient most often appears angry, but anger can mask a number of emotions besides anger, the biggest of which is fear. Substance abuse, mental illness and dementia are also factors that contribute to angry behavior.
- The first step in diffusing a patient’s anger is to remain calm yourself. Don’t allow yourself to be swept up in the patient’s anger.
- After the outburst, acknowledge the patient’s feelings and let the patient know you understand.
- Find something to agree on with the patient, such as acknowledging that his or her complaint is a valid one, suggests the Healthcare Providers Service Organization.
The number of Know-It-All patients has increased dramatically since the dawn of the Internet, with many people turning to “Dr. Google” for medical advice. These patients (and their families) may arrive with a stack of information on how to treat their ailment and refuse to believe otherwise. The underlying emotion is fear, and many patients attempt to get back in control by arming themselves with information.
- It’s important to not feel attacked by their behavior, and to instead empathize with the patient.
- Praise them for their initiative in managing their disease and suggest that there may be other treatments options that are backed by evidence-based research.
A patient who says, “I have a high tolerance to pain medications, so I’ll need a higher dose,” is most likely a manipulative patient. People suffering from substance abuse disorders can be manipulative and will threaten, cajole or throw a temper tantrum in an effort to get their way.
- Nurse Lynda Lampert says your best strategy is to avoid countering what they say because you are not likely to win the argument. Lampert says these patients are “stuck on their version of events and will not budge from their beliefs.
- She recommends that nurses instead recognize the emotions that may come up when dealing with this type of patient and to not let those feelings overwhelm you.
Demanding patients are similar to manipulative patients with their direct, in-your-face approach. Their demands usually come in the form of a threat, and their behavior is often a cover for fear.
- Correctional nurse Catherine Knox knows firsthand how to manage demanding patients and recommends using an empathetic approach (which may not be your first inclination).
- Knox suggests saying something like, “I want to be able to provide you with great care, but we need to work together in a respectful way. Let’s talk about the best way to do this effectively.” She says this approach demonstrates that you’re listening and usually calms the patient down.
The needy patients are the ones who incessantly ring the call button for seemingly insignificant requests. And sometimes it’s a family member who is pushing the button. Needy or anxious patients are most often frightened and may have unanswered questions about their condition.
- Ask questions to get at the root of the problem and calmly answer the patient’s questions.
- In the case of a needy family member, give them a task to do, such as applying a cold compress to the patient’s forehead or other helpful task. It gives the family member a way to feel less helpless about their loved one’s situation.
How to handle a difficult patient
Once you recognize what type of difficult patient you’re up against, you can follow these helpful strategies for effective communication:
- Stay calm. Take a few deep breaths before responding. Refuse to take the bait and engage in the angry or demanding patient’s argument. Preston Ni, a communications professor, points out the less reactive you are to the difficult patient, the better you can use your judgment to handle the situation.
- Don’t take things personally. You can do this by reframing the behavior. As Ni explains, “people do what they do because of them more because of us.” When you expand your perspective and realize the angry words aren’t personally directed at you, you can respond more objectively.
- A little empathy goes a long way. Put yourself in your patient’s shoes and think about what he or she is dealing with. Complete the following sentence in your head, “It must not be easy…” and shift your perspective toward problem-solving mode.
- Put the spotlight back on them. With demanding and know-it-all patients, they place attention on you to make you feel inadequate. They’re quick to point out what’s wrong. Ni says a simple and powerful way to change this dynamic is to put the spotlight back on the difficult person by asking questions. He suggests asking constructive or probing types of questions to neutralize the attack.
- Acknowledge your limitations. Even Superman has his kryptonite. Some patients will push your buttons more than others, and in these cases, it may be best to switch care management with a co-worker. You can help each other out when the occasion arises.
- Lynda Lampert, RN, "How to Handle Difficult Patients," Ausmed Education
- Catherine Knox, "Dealing with the Difficult Patient," Essentials of Correctional Nursing
- "Dealing with the Difficult Patient," American Society of Registered Nurses
- Preston Ni, "Ten Keys to Handling Difficult or Unreasonable People," Psychology Today
- "Handling the Angry Patient," Healthcare Providers Service Organization
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