Question
How do you deal with challenging patients?
Answer
Definition of a Challenging Patient
Based on the research, people who do not assume the patient role expected by health professionals may have different values, beliefs, and personal characteristics and may be called difficult patients. Difficult patients are defined as those who elicit negative emotions, like fear, anger, and frustration, from health professionals. According to the literature, 20% of patients are perceived and stigmatized as difficult by healthcare professionals.
Factors Influencing Challenging Behavior
- Person is more challenging ‘in nature’
- Previous challenging behavior in similar circumstances has resulted in reward/success
- Person believes that goals will be best achieved through an aggressive response
- Frustration (e.g., from an inability to communicate effectively)
- Person feels threatened
- Person feels powerless
Difficult patients can be more challenging in their nature or have had previous challenging behavior that resulted in a reward. They believe that their goals will be best achieved with that approach. They may demonstrate frustration, for example, because of their difficulties communicating. The person may also feel threatened or powerless.
- Person is in pain
- Pressure from friends to behave aggressively
- Person feels justified by being angry
- Person expects to be confronted/treated with hostility
- Person has been in conflict with the individual in the past
- State of physiological arousal (e.g., anxious)
- Others are behaving aggressively around
They can be in pain or receive pressure from friends to behave in a challenging way. They feel justified by being angry and expect to be confronted and treated with hostility. The person may be in conflict with a particular service or with a specific individual. They may have increased states of psychological arousal if others are behaving in an aggressive way around them.
Behaviors That Encourage Challenging Behavior
- Adopting a patronizing attitude
- Humiliating or talking down to patients
- Using wrong names or inappropriate forms of address
- Using jargon and overfamiliarity
- Telling patients how they feel
- Trivializing a patient’s problems
- Telling patients they are wrong to feel/behave as they do
There are also behaviors that can encourage challenging behavior from our side, like adopting a patronizing attitude, humiliating or talking down to patients, using wrong names or inappropriate forms of address, using overfamiliarity, telling patients how they feel, trivializing their problems, and telling patients that they are wrong to feel and behave as they do. We may do these things when we are exhausted or have back-to-back appointments.
Get Ready!
- Be familiar with the following policies:
- Safeguarding, health and safety, lone working
- Review notes
- Get to know your patients (e.g., baseline behavior, history, triggers, and coping strategies related to negative feelings and interests)
- Be aware and recognize your limits -> know when to seek additional help
How we can get ready? We can get familiar with our internal policies around safeguarding, health, and safety policies, and review the notes before we start working with the patient. We need to get to know their baseline behavior and interests because that will help us to de-escalate situations.
Coping strategies related to negative feelings include recognizing our own limits and knowing when to seek additional help. Sometimes, seeking help is the most professional decision we can make.
This Ask the Expert is an edited excerpt from the course, Patient engagement strategies, by Tania Sofia Nogueira.
