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Improved listening, understanding may help ease encounters with difficult patients, parents
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Recognizing the physical or emotional responses triggered by challenging patients or families may allow the provider to effectively partner with, instead of confront, the patient or the family.
A special article recently published in Pediatrics offers possible solutions for how to deal with problems that may arise when faced with a difficult patient or a patient’s family.
Challenges during patient visits may be traced to patients, parents, physicians or health care system factors. Patient or parent issues may include psychiatric disorders, personality disorders, subclinical behavior traits and information overload, according to the special article written by Cora Collette Breuner, MD, MPH, and colleagues.
Physician features may include poor interaction or communication skills, inadequate experience with difficult patients or general unease with diagnostic uncertainty. Issues related to the health care system may include productivity and finance pressures.
Russell W. Steele, MD, head of pediatrics infectious diseases at Ochsner Children’s Health Center and clinical professor at Tulane University School of Medicine, told Infectious Diseases in Children that The House of God: The Classic Novel of Life and Death in an American Hospital by Samuel Shem is required reading on his rotation, “because it helps provide a certain perspective to young physicians about their patients.”
The Pediatrics article outlines strategies based on a review of the current literature for pediatricians to approach these challenging situations and still provide the best quality of care for the patient.
“The issue of accepting that there are going to be difficult encounters is half the battle,” Steele said. “People probably just need support. The one thing that is quite clear is that if you are just nice to people, that is probably the best medicine that you can afford them, and the children get better.”
According to the article, the encounter can be broken into four aspects: patient characteristics; difficult parents; physician factors; and health care system factors.
Approaches to handling the difficult encounter with a patient or parent include: a patient assessment and referral that offers a team approach; physician communication; practice modifications; and physicians’ self-care, according to the paper.
Richard Lander, MD, a member of the Infectious Diseases in Children Editorial Board, also offered advice drawn from his 31 years in practice.
“I try to provide information that I know is sound. If I have someone who is refusing treatment that would save the child’s life, then I report them to Division of Youth and Family Services,” Lander said.
When dealing directly with a difficult child or patient, it can depend on the age of the patient. When dealing with a teenager, he said he generally will ask the parent to wait outside so the teenage patient may have privacy and speak freely.
“I also ask the teenage patient if I can speak to their parent about the issues we discussed,” Lander said.
Pediatricians have unique challenges when providing care in difficult situations that involve challenging patients or parents. Future studies should investigate difficult clinical encounters in the pediatric setting. Strategies for improving difficult scenarios may include physician adaptation of approach toward difficult patients and parents, improved communication awareness and skills, and modifications in the practice structure, according to the study authors.
“The pediatricians’ sense of pride in their work when they can steer a difficult encounter toward health is rewarding,” they wrote. – by Cassandra A. Richards
Disclosure: Drs. Breuner, Lander and Steele report no relevant financial disclosures.
For more information:
- Breuner CC. Pediatrics. 2011;127:163-169.