The difficult patient: who he is and how to deal with him

Abstract

The daily work of health professionals brings them into contact with all types of people. This implies a high emotional content and a subjective component, which can come to the surface when least desired, and, depending on how one is able to deal with them, give rise to upsets or satisfactions. It is estimated that between about 1 and 3% of the users who are seen daily in the surgeries are listed as difficult patients by the different health professionals. It is important to understand that such difficulty cannot exclusively be apportioned to the patient, but that the individual characteristics of each professional also contribute to this. It is very difficult to establish unequivocal patterns given that such different nuances exist in each inter-relation. Different definitions exist about patients who are difficult to deal with. O'Dowd defines them as a heterogeneous group of patients, frequently affected by relevant diseases, whose only common feature is their ability to produce distress in the doctor and the team attending to them. The aggressiveness shown by patients in consultations is related to variables such as perceived seriousness, consequences, rights that they think they have, and the reciprocity they expect from the professional. Patterns of approach include acting on the milieu, the profile of the professional and specific approaches to difficult patients, attempting to change an initial attitude of rejection for one of co-operation with, and help for the person who is suffering.