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WHOISTHEDIFFICULT PATIENT?
One who impedes the clinician's ability to establisha therapeutic relationship
A person who does not assume the patient role
expected by the healthcare professional, who mayhave beliefs and values or other personalcharacteristics that differ from those of thecharacteristics that differ from those of thecare-giver, and who causes the
caregiver to experience self-doubt"
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THEHOWTOOF DOCTOR-PATIENTCOMMUNICATION
All communication problems are relationshipproblems.
When communication is difficult, the physicianshould reflect on his/her possible contributions tothe difficulties.
Talking about fears, worries, & the impact of theillness on the patients life is always therapeutic.
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WHOISTHEDIFFICULT PATIENT?
Typical Difficult Patients:
Angry patients
Patients in pain
Anxiouspatients
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UNDERSTANDINGAN ANGRY PATIENT
Mostly due to:
Unmet expectations
Having a disease (suffering the
consequences) Long waiting time
(Perceived) unfair treatment
Inefficient / unfriendly /
unresponsive staff
Wrong diagnosis / treatment
Missed diagnosis
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THE SKILLS
All the ones you learned previously AND
1. Interpersonal space
2. Reflection (statement of an observation of a
feeling or verbal response)3. Facilitation (any comment or behaviour that
encourages elaboration)
4. Personal support
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WHATYOUSHOULDDO
Reflect You look a little upset.
Pause and be attentive
(facilitate)
Tell me about whats upsetting
you.
Acknowledge the difficulty Having to wait for 2 hours is
really a long time. Please accept
my apologies.
Find out the specifics Tell me more about what the
receptionist said to you.
Express empathy Its very frustrating to wait for so
long.
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Guess the meaningbehind the anger
Was it frustrating because you felt
it was a waste of your time?
Take an action on
patients behalf
Ill find out what caused the delay.
Maybe it is something that can beavoided the next time.
Link the patient withresources
Would you like to register a
complaint?
Transition to purpose ofvisit
Well, now that you finally got to
see me, what can I do for youtoday?
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UNDERSTANDINGA PATIENTIN PAIN
Mostly due to:
Immediate pain symptoms
Reduced mobility
Increased dependence Worry about condition
Expects immediate relief
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WHATYOUSHOULDDO
Observation
Verbalizes specific
expressions
Showing some form of
concern
Observe with youreyes, ears, nose,hands
I can see that you
are in pain
It must be difficult for
you to ..
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WHATYOUSHOULDDO (CONT.)
Explaining the need forcooperation
The information is important for
us to understand your condition.
Encouraging &reinforcing positivechange
How are you feeling now?Can we continue?
Establishing &
maintaining control ofthe situation
I understand the:
pain you are going throughthe difficulties you have facedbut
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IDEALDOCTOR-PATIENT RELATIONSHIP
What is Partnership?
Partnership implies a team approach , in whichpatient & doctor work together toward the samegoal.
The use of the pronouns We&Usexpressespartnership.
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EXAMPLE
Lets work togetherin looking at this problem
Lets figure out a way (together) to help you with
this problem
Perhaps we canwork together to make you feelbetter
Together we canwork out some solutions that mayhelp after wehave talked some more about yourproblems
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UNDERSTANDINGAN ANXIOUS PATIENT
Mostly due to:
Medical conditions
Worry about self or family members
Missed / lost opportunities Misunderstanding / myths / hearsay
Stigma
Family history
Fear
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EXPLORATION
The primary communicative intervention forpatients with anxiety is to explore concerns & fears.
"When you think about your illness, what are youmost afraid of?"
Yes, we hear about cancer everydayCan you tell
me what makes you think it could be cancer?
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SOME TIPS
Listen. Anxious patients are usually eager to telltheir stories. Make eye contact. Give them enoughtime.
Ask open-ended questions. Express genuineconcern for their suffering and offer hope that theywill feel better. Make it clear that you take theircomplaints seriously.
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SOME TIPS(CONT.)
Summarize what you believe you have heard andinvite your patient to clarify your perceptions.
Ask them whether there are any other importantthings they want you they want you to know, andwhether they to know, and whetherthey believe you have a goodunderstanding of their case.
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HOWTO COMMUNICATE EMPATHY
Verbal (other than I understand)
I really feel bad for you.
That must be very difficult for you to cope with.
You seem (sad / angry / stressed) today. This cant be an easy time for you.
Well work together to get through this.
Please call me anytime.(If you say this, be sure
that you can make yourself available).
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HOWTO COMMUNICATE EMPATHY
Non-Verbal
Using a sad or sympathetic tone of voice
Expressing concern through your facial expression
Touching a patients hand / pat on the shoulder
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TAKEHOMEMESSAGE
All of your knowledge about dealing with difficultpatients will be of no value unless you master aclinical approach that allows for a caring attitude, athoughtful evaluation, and an accurate diagnosis
and appropriate treatment.
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