How Respected Family Physicians Manage Difficult Patient Encounters

  • Elder N
  • Ricer R
  • Tobias B
  • 65

    Readers

    Mendeley users who have this article in their library.
  • 49

    Citations

    Citations of this article.

Abstract

Background: Nearly all family physicians have patients that engender a sense of frustration or dislike, often described as "difficult." Most research in this area focuses on describing these patients and their physicians, not management or coping. Objective: To describe how respected family physicians identify, manage, and cope with difficult patient encounters. Methods: Qualitative semi-structured interview study. Participant physicians described as "excellent" were recommended by medical school family medicine faculty around the county. Interview questions included "describe the patient you least like seeing," and "how do you keep sane but still assure adequate care for the patient?" Interviews were analyzed using the editing method, looking for common categories and themes. Results: 102 physicians were interviewed. Physicians described both patient behaviors (stay sick and demanding) as well as medical problems (multiple, chronic pain, drug seeking, psychiatric) that they found frustrating. Difficult encounters occurred when these patient behaviors and medical problems clashed with physicians' personal and practice traits. Their management strategies to return the encounter to success incorporated collaboration, appropriate use of power and empathy. Conclusions: We propose a model where clashes between patient behaviors and physicians' traits turn a successful encounter of collaboration, appropriate use of power and empathy into a difficult encounter of opposition, misuse of power and compassion fatigue. Management strategies used by our participants aim to return success to the encounter and may serve as a guide for practicing physicians and for future research.

Get free article suggestions today

Mendeley saves you time finding and organizing research

Sign up here
Already have an account ?Sign in

Find this document

Authors

  • N. Elder

  • R. Ricer

  • B. Tobias

Cite this document

Choose a citation style from the tabs below

Save time finding and organizing research with Mendeley

Sign up for free