Difficult patient visits: five questions to help you manage them more effectively

An estimated 15 percent of patient encounters are considered “difficult” by physicians. These visits often involve patients with mental health disorders, multiple (more than five) symptoms, chronic pain, poor functional status, unmet expectations, reduced satisfaction, and greater use of health care services. But these challenging visits can be professionally rewarding if you take the right approach.

Before the patient visit, ask yourself the following questions:

• Why do you consider this patient difficult? (Example: He never takes any responsibility for his diabetes.)

• What biases and assumptions might you have? (Example: He will never change his ways.)

• What is your agenda today? (Example: I want to discuss his dietary habits.)

Take a breath. Then go into the exam room and, as the visit unfolds, ask yourself these additional questions:

• What is the patient’s agenda? (Example: He wants to understand why he has constant numbness in his feet.)

• What social history could you gather that would enable you to further explore your assumptions? (Example: Who provides meals at home? Are financial or family issues affecting his food choices?)

Taking a few minutes to understand the patient in his or her unique social context and to acknowledge that the patient’s agenda is distinct from your own can set the stage for a more productive, collaborative visit.

Read the full FPM article: “Rethinking the Difficult Patient Encounter.”