Doctors dealing with difficult patients, is it the fault of young physicians?

A study released last week reported doctors found that one in six patients were “difficult.”

In addition, physicians who reported these difficult encounters tended to be young and female, leading to a 12-times increased risk of burnout.

Like any relationship, be it a marriage, job, or one between a physician and a patient, not all encounters are going to go smoothly. The editorial commenting on the article suggested, unsurprisingly, that doctors need “better training,” and reforms that “better reimburse doctors for more ‘talk time’” would help.

Failing those options, doctors are nonetheless expected to “rise to the challenge” and deal with less than ideal patient encounters.

So, what to make of the finding focusing on young physicians? Family doctor Doug Farrago thinks it’s simply a matter of experience. “The reason that older docs can handle these patients better is that they have been around the block,” writes Dr. Farrago. “They have learned defense mechanisms to let tough encounters slide off their back. They can laugh at it all and use humor in an appropriate manner both with their patients and with their colleagues . . . The younger docs just need seasoning or they will realize that this job isn’t for them. That is just human nature.”

Duncan Cross discusses the study from a patient standpoint, and observes that “too many doctors encourage – or even demand – that their patients identify them (the doctor) as the sole source and authority for their medical care.”

That’s an unacceptable stance for physicians to take. I realize that my practice style may not be an ideal fit for some patients, and am never offended if a patient seeks another opinion, or transfers their care.

No matter what the situation, the bottom line is this: don’t be a jerk. That goes for both doctors and patients.

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  • Anonymous

    The worst thing you can do when there’s trouble in the doctor/patient relationship is look to the Patient Relations office to help mediate. If you’re a well-intentioned patient who just wanted a little better communication, it can be quite a surprise to suddenly find yourself receiving hostile letters from risk management attorneys making deliberately vague accusations against you, I assume in an attempt to shield the doctor from risk by laying the foundation for a defense against a malpractice suit that exists only in their overly fertile imaginations. Either that or they just get off on being abusive to patients they’ve never even met.

    Anyway, I’ve ever met a doctor in whom I couldn’t find something to like and admire. But I really, really hate some of the robots you surround yourselves with.

  • hal

    Anonymous, please. When does that ever happen? I work at a major medical center and the PR dept here does no such thing. The only time a patient receives discharge letters in when they do something extreme; threaten violence, steal rx pads etc. No one gets “threatening” letters because they just wanted better communication.

  • Anonymous

    Hal:

    Is your Patient Relations dept. a subset of, and report to, the risk management attorneys? This one does, and I’ve learned not to trust risk management attorneys any more than you probably trust malpractice attorneys.

    And I didn’t say I received “threatening” letters. Check the post. I referred to “vague accusations”. They wrote that I was being dismissed “due to past interactions.” Ever try to defend yourself against something like that? Of course everyone will assume it must be something extreme as you describe. No one’s going to think, “Oh, he must have complained about a lack of communication.” Thus, why even bother trying to correct the problem…no need to waste time investigating…patient must be lying…

    Hal, please. If your clinic’s PR office operates as you say, congratulation and good for you. Don’t assume it’s the same everywhere else. It’s not.

  • Anonymous

    I finished my residency in family practice over 10 years ago and I have been practiticng ever since. During that time, I have become less, not more, tolerant of difficult patients.

    Nothing could have prepared me for the epidemic of narcissism out there. After having cases such as a young mother losing her life to melanoma, I frequently feel like saying “stop whining. There are things in the universe other than you.” Just because you cannot walk in and be seen for the sniffles does not mean that I am negligent in my duties. Likewise, do not think I don’t care because I cannot address your entire laundry list during am acute visit. And don’t complain about waiting when you were 10 minutes late yourself. And don’t yell at my office staff because I will not call in an antibiotic for you. And don’t tell me I just want your stinking 25 dollar copay. And don’t call me after hours unless it is an emergency. And don’t tell me “that’s why you make the big bucks.” And don’t decline to come in for an appointment but then have the chutzpah to ask which orthopedist I recommend for back pain.

    Oh vey.
    Who’s got a laundry list now?
    What a catharsis.

    These are just a few items.
    I wish I could say all of these things were unusual, but unfortunately they are all commonplace.

    Patient’s don’t respect primary care. They abuse it.

    A family practitioner

  • Anonymous

    My former clinic’s patient relations department was generally also very patient friendly–until they thought the patient was moving towards a litigious position, then they went into a risk management mode. It wasn’t hostile even then but it is not really possible to be warm, open, and helpful while being guarded, meticulous and cya at the same time. I thought however that sometimes they didn’t cya enough. Most of the docs let things go too far before discharging patients and even then usually got more obstruction from patient relations than help. They quite foolishly in my opinion actively sought to get doctors in the partnership to keep treating patients who filed lawsuits against a member of the partnership. That, in my opinion, is unwise for both the doctor and the patient.