July 12, 2023

Most podiatric physicians know exactly how to handle a patient with heel pain, from diagnosis to treatment options. But a patient who is angry about the office running late, or one who can’t seem to follow doctor’s orders can be a significantly larger challenge. John Evans, DPM, chief of podiatry at Beaumont Hospital in Dearborn, MI, will address difficult and non-compliant patients in his plenary lecture this morning.

“The whole purpose of this talk will be to give physicians who are already experts in dealing with patients’ conditions some ideas about what other experts feel are the best ways of handling these challenging situations,” Dr. Evans said.

Attendees may be surprised, he said, to find how much of the solution starts with them. “The most useful tool I have found in dealing with difficult patients is to first understand what’s going on inside of my head.” Understanding your own mood, stress, fatigue, and more can go a long way toward helping you keep your cool when faced with an angry patient.

“This is all about how we communicate—how one person will interact with another, how one person understands what someone else says.” Patients, he said, are often in pain or anxious about their condition, and family members are worried about their loved one. Complicating matters are short appointment times, the need to document a visit in an EHR, and interference from insurance companies—the realities of modern medicine. Physicians have to take all those factors into account to understand what may be motivating a difficult patient to react the way they do.

In addition to understanding your own emotional status and trying to put yourself in the patient’s shoes, Dr. Evans recommends trying to be yourself—“the person you were before you were a DPM. We all assume a certain role as a physician when we walk into an exam room. Just be the person you are. Greet the patient in a friendly way, make eye contact, be aware of your body language, smile, try not to seem rushed.”

He also advises his peers to really listen to what the patient has to say. “There are studies that show a physician will cut off a patient after they have been talking for less than 20 seconds—you miss the boat when you do that.”

Dr. Evans will also cover various maladaptive coping styles—the archetypical “difficult” personalities—and the literature on how best to deal with them. He will touch on workplace violence and the red flags to watch for in patients who could become more than just challenging. Dr. Evans said most discussion of this topic is related to institutional or hospital settings with security and significant resources for staff training, but it’s important to be aware that violence can happen in the outpatient clinic setting.

“I can’t do much about a patient being difficult. But I can do a lot about how I behave and think,” Dr. Evans concluded. “I can try to hear what they’re saying and see why they’re being non-compliant; I can evaluate whether this person has valid reasons for being angry; I can try to understand whether they’re in pain or afraid.”

Attendees will have access to Dr. Evans’ slides, which include a wealth of articles and references to use in their own practices.