What is a "problem patient"?

According to this article, someone who fits this bill:

Problem patients may exhibit traits that include lengthy care histories from many providers, courses of care dominated primarily by emergency visits, constant complaints about past or current care, ongoing failure to pay for services, and consistent failures to adhere to advice and instructions. These traits are common in plaintiffs and litigious patients. Prudent practitioners who identify these traits early may discharge or not accept these patients. Often, such decisions save time, money, and aggravation. If you care for such a patient, document the care and issues of the problem.

(via The Patient’s Doctor)

Comments

Anonymous
I have often wished that a patient would have a “null sign” printed on their forehead for those I should never do any surgery on. These patients usually come with vague, non-classical symptoms and then ending up getting a radiological study that the clinician must rule out (e.g. engorged appendix, rule out early appendicitis) via surgery. Then the patient has multiple complaints regarding the surgery (and of course the appendix is pathologically normal). The family questions your reasoning for taking out the appendix – (Well, the patient complained of abdominal pain and unfortunately, the CT scan backed you to the wall) – even though you carefully counseled (and documented) that this may not be appendicitis, but the patient agreed anyway to have his/her appendix removed. It’s always these borderline personality type patients who have had multiple surgeries, i.e. hysterectomy, cholecystectomy, appendectomy, arthroscopies, etc. and they are diagnosed with diseases like fibromyalgia and irritable bowel syndrome and migraine headaches. When one of these charts comes to my door, I just roll my eyes and groan…
Anonymous
I hve one of these, I hav3e been seeing her for 20 years. I confess that I operated on her for 3 or her 43 surgeries. She is a borderline personality. I see her for chronic pain only and we have an agreement that I will never under any circumstances of any kind, do any surgery on her. I require a chronic pain contract and a consult from a tertiary pain center once a year. She is on mega-doses of narcotics and benzo’s but is fairly functional and we have a reasonable and amicable relationship. But- she makes me very nervous. Borderlines are very scary people.
Anonymous
Just out of curiosity, is surgery the normal treatment for borderline personality disorder? How about for headaches and fibromyalgia? If not, I’m a little confused as to exactly where the fault lies if a patient has a lot of surgeries. One doctor here complains about a patient who questions the need for surgery at the same time he suggests a patient’s having multiple surgeries is apparently evidence of a personality disorder. The other says he performed 3 out of a patient’s 43 surgeries before putting his foot down and saying “no more!”
Do doctors just perform surgeries for the hell of it, or when the patient insists on it when there is insufficient evidence to warrant it? If so, then that sounds like malpractice to me, and labeling a patient as “borderline” for following the doctor’s advice seems like adding insult to injury. If there is a legitimate need for the surgeries, then what difference does it make how many surgeries a patient has? If there isn’t a legtimate need, then the doctor is taking advantage of a gullible patient.
I know from experience this is a difficult concept for many doctors to wrap their minds around, but a patient can have more than one thing wrong with them at a time. Having multiple complaints is not synonymous with BPD. Many “problem patient” situations arise out of contact with “problem doctors” suffering from the God Complex, who feel they cannot be questioned by a lowly patient and are too full of themselves to have much if any empathy for a mere peasant.
Of course, it doesn’t take too much wisdom to refuse surgery when the doctor “suggesting” you get it is telling you acupuncture is fine, if you don’t mind getting AIDS from the needles, or another one who took a quick look at my CT Scan, and then said “congratulations, you don’t need surgery” before doing an equally quick double take and saying “on second thought, you *do* need surgery. You have a blah, blah, blah in the blah, blah and will require a mumble, mumble (myofascial laminectomy for spinal stenosis, low-back). I’ll give you one month to decide whether to have the surgery or live with pain for the rest of your life.” But what about when the con-man has a better line of BS than these two did? It could be easy even for a highly intelligent patient to fall into an opportunistic doctor’s trap and consent to a surgery he doesn’t need.
I’m one of those people with multiple chronic pain complaints and am therefore a drug addict, malingerer, whiner and Al Qaeda supporter and I am just waiting for a doctor to sneeze in my face so I can sue him out of business when I catch the flu. I have no intention of ever getting better, and the years of torture I endured and the thouands of dollars I spent trying to get better were in fact an attempt to get worse, so I can continue to enjoy secondary gains. Or at least, this is how your profession tends to see people like me, and you’re not afraid to write that in a patient’s chart and insist he still has to pay you after you do.
So understand that when you’re dealing with a “problem patient” the odds are good you may have someone on your hands who’s been seriously used and abused by your profession, and has an attitude because of it. While you’re not personally responsible for the actions of other doctors, neither is your patient responsible for any bad interactions you may have had with similar patients. It is your duty to treat the patient professionally and objectively and if you can’t do that without attaching a convenient (for you) label, then you are part of the problem, not the solution.

What is a "problem patient"?

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