More than a third of physicians have experienced verbal or physical abuse from patients or family members of patients during COVID-19, according to a recent survey by Medical Protection.
What makes an interaction challenging?
Factors that contribute to a difficult situation can come from many sources, but can be grouped into the following categories: patient, doctor, disease and system.
The more factors that come into play, the more difficult it will be to manage the interaction with the patient effectively. Being aware of these factors and taking steps to reduce them could help avoid difficult interactions. Labeling the “interaction” rather than the “patient” as difficult creates opportunities to influence our perception of that difficulty.
However, there are several reasons why patients become defiant.
Patients, and sometimes their caregivers, become defiant, difficult, uncooperative, or aggressive for various reasons:
- Being sick or in pain
- Alcohol / substance abuse.
- Fear, anxiety, or anguish
- Communication or language difficulties.
- Unrealistic expectations.
- Bad previous experience.
- Frustration.
- Guilt for not bringing a sick relative earlier.
Their behavior can take the form of:
- Being demanding or controlling
- Unwillingness to listen / lack of cooperation
- Verbal abuse or threats
- Physical violence against people or property.
Why are challenging interactions bad for everyone?
According to BMJDifficult interactions with patients can consume a disproportionate amount of the physician’s time, resources, and emotional energy. PThey can make the doctor feel stressed, anxious, angry and helpless, and can even lead to dislike of the patient and the use of avoidance strategies. This response could compromise the physician’s ability to provide good care and put the physician at greater risk for errors, which can affect the patient’s clinical outcome.
A difficult interaction will leave both the doctor and the patient frustrated and dissatisfied, and can decrease trust in the doctor-patient relationship. As a result, the patient is more likely to make an appointment with another doctor in the office for a second opinion. Or in that case, report to the hospital emergency department, which ultimately leads to greater use of health care resources.
What can you do?
Patients should not be denied necessary treatment even if they are aggressive or violent. Treatment should be based on clinical need, no matter how demanding the patient.
However, you must assess and minimize the risks to yourself, the patient, and others. In some cases, it may be reasonable and necessary to consider alternative arrangements for providing treatment.
If systems, policies, or availability of resources are compromising patient care, you should raise your concerns.
It is advisable to train staff in conflict resolution and aggressive behavior management.
REMEMBER:
* Focus on finding solutions rather than areas of disagreement.
A solution-focused process shows that you are working as a team with the patient.
Encouraging the patient to come up with options and working together to agree on a mutually acceptable solution can relieve the physician of being the sole manufacturer of solutions.
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