Physician attitudes about care, fatigue, stress and burnout can create circumstances in which physicians are responsible for the difficulties.
Language barriers, cross-cultural issues and the need to relay bad news can also make for challenging encounters.
Clenched fists, furrowed brows, wringing of the hands, restricted breathing patterns and warnings from office staff that something is wrong can help to identify these patients.
When you see these signs, try to uncover the source of difficulty for the patient and pay attention to the way his or her emotions relate to the medical issues at hand. Instead, define your boundaries and recognize when your “triggers” are invoked, as this will help you to modulate your response to the situation and allow you to empathize with the patient.
Use reflective statements such as, “I can understand why you might feel that way,” and follow with a discussion about what it might take to resolve the situation23For example, a patient who is in pain and has been waiting for an hour because you have been tending to a hospital emergency might be quite angry when you finally get to the room. I don't understand why I had to wait.” Your own sense of being harried and running late may trigger an angry reaction from you, but simply taking a deep breath and offering a sincere apology would be a more constructive response than having your own meltdown.
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As many as 15 percent of patient-physician encounters are rated as “difficult” by the physicians involved.1 Patient characteristics that suggest the likelihood of difficult encounters include the presence of depressive or anxiety disorders, more somatic symptoms and greater symptom severity, according to the study.
Not all difficult encounters can be blamed on the patient side of the interaction.
The Joint Commission added a new Patient Safety Systems (PS) chapter that became effective on January 1, 2015, and highlights the accreditor’s patient safety requirements.
The new chapter explains how to become a learning organization, the role of hospital leaders in patient safety, use of data and reporting systems, conducting proactive risk assessments, and patient involvement.