How Can I Deal With 'Difficult' Patients and Families?

Sheila M. Bigelow, DO

Disclosures

April 03, 2014

Question

What are some techniques to use with difficult patients and families?

Response from Sheila M. Bigelow, DO
Resident Physician, Pediatrics, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio

As a pediatric resident, I work with many different families and patients of various ages and backgrounds. Sometimes a family or patient is more difficult to work with than others. Often, the foundation of these issues has to do with poor communication and misunderstandings between the physician and the patient and family. Here are a few important ideas and skills to use when presented with a difficult situation with a patient or family.

Listen actively. "Active listening" means that when the other person is talking, you stop and listen. Do not sit there thinking about what you are going to say next while waiting for the other person to finish speaking. Just listen, and understand what they are saying.

Obviously, this is paramount to our jobs as physicians, but often we can let this skill lapse. This happens more often when we are upset or not understanding why a family is making a certain choice. Sometimes we let our skills slack when we are busy running around the clinic. Sometimes a patient or family just needs to vent. Most often, the skill of active listening will ease a difficult situation.

Give them some control. Having a child admitted to the hospital is scary and frustrating. For most parents, this is fortunately a very rare event. They are catapulted into a world where they have to ask a nurse for a dose of acetaminophen, and then the nurse needs to wait for the resident to put the order in. A few hours earlier, at home, the parents were able to provide this to their child themselves. Their attitudes and disagreements with your treatment plan may have nothing to do with the plan itself, but everything to do with having nothing under their own control.

Holding family-centered rounds and allowing patients and families to be involved with the treatment plan can provide the family with a sense of input and a degree of control.

Ask questions. Sometimes, patients and families will become upset over everything, when in reality only one thing is bothering them. If you can figure out what is at the foundation of their emotions, you can work on fixing the problem. For example, are they unclear about why their child can't have anything to eat or drink before a scheduled test? Or are they unsure about why the test was ordered in the first place?

Social history is an important part of your admission history and physical. Not only can it reveal risk factors, such as smoke exposure in a child with asthma, but it allows you to better understand your patient and family's background. Perhaps the family who will never agree that their child is ready for discharge does not have a safe place to go after discharge.

Involve the patient and family. Encourage your patient and his or her family to write down questions, concerns, healthcare providers' names, and any other information they may find useful. Being admitted to a hospital, especially a teaching hospital, means talking to many individuals who do not always deliver a consistent message. By the time the admitting attending physician is speaking with the patient, the family has already talked to an emergency department (ED) triage nurse, an ED resident physician, an ED nurse, the ED registration staff...I think you get the idea.

Families have to talk to a lot of people with titles that all sound very similar. One person may say it will just be 1 night in the hospital, another will say 2 nights, and yet another will not give a timeline.

It sounds like mayhem, and I am sure that it feels that way to many families. Having families write down individuals' names and then explaining what the various titles mean can help patients feel more aware of their surroundings.

Many medical terms and concepts come up during a hospital stay. Patients will often think of questions after rounds, only to forget them before they see another member of the healthcare team. Encouraging them to write their questions down and be involved in their treatment plan will help prevent confusion and disagreements. Answering their questions and educating them on disease processes can demystify the hospital experience and prevent some of the uneasiness.

Stay professional. Remember that we all come from different backgrounds, with various life experiences and problems. Feeding into disagreements with a poor attitude or unprofessional behavior is only going to worsen the whole situation.

Put yourself in the family's shoes; think of the patient as your own nephew or child. Treat the family as you would hope that a physician would treat your own family and loved ones. It can be hard when, in the heat of the moment, the patient or their family says something rude, but to respond in a similar fashion is poor form and is likely to worsen a physician/patient relationship that desperately needs to be strengthened.

If you feel as though your temper is starting to boil, take some deep breaths, leave the room if you can, and come back when you have both cooled off a bit. At times, another physician might already have a strong relationship with the family. Know what is best for you and the family, and know when it's best for you to step aside if feasible.

Being in the hospital is a very stressful time for our patients and their families. It leads to higher emotional levels than experienced in day-to-day life. It is a set-up for disagreement. However, with careful listening, compromising, and patient and family education, the patient and family can have a better experience during a tough time.

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