Mastering the medical mindshift: The label of „difficult patient“ arises mainly from a lack of communication skills

Data, facts and instruments on the German health system

What it’s all about

Every doctor and every medical assistant knows the small negative events that, to a greater or lesser extent, pervade everyday practice. Often they are related to patients who are then labelled „difficult“ and with whom this stigma is forever associated. But the assessment is often made hastily and the real problem lies at a completely different level. Being aware of this and taking countermeasures can decisively improve the quality of work.

Specification of the term

„Oh no, Mr. X is about to come in for a blood sample, that’s going to be something again!“ Anyone who classifies a practice visitor as „difficult“ should first check whether they are actually a „real“ problem patient or whether

  • this classification has perhaps only crept in because a colleague or practice partner has at some time complained about difficulties in dealing with them,
  • a practice visitor is simply unpleasant to deal with? Often these are characteristics, behaviours and ideas that are alien to oneself and / or that one finds disturbing and unpleasant, e.g. because very intensive enquiries are made,
  • the problem the patient is talking about is „annoying“ because it cannot be solved and the frustration is transferred to the patient, or if
  • the work pressure is so high that delays in the process have serious consequences due to „unconventional“ patients.

Failure to react leads to label formation

Experience has shown that clarifying this question helps to significantly reduce the number of „difficult“ patients. But even the remaining residual group is not objectively defined, because

  • phlegmatic patients, cholerics, frequent talkers or similar persons do indeed show more conspicuous or deviant behaviour than other practice visitors,
  • but their classification is always subjective and caused by the fact that one does not have a suitable counter-strategy.

A difficult patient is in most cases a personal problem of not being able to communicate adequately and thus not being able to handle the exception situations.

Example: How can dominance be countered?

A difficult conversation situation arises, for example, when patients treat medical assistants from above, dominate them, and in extreme situations even try to belittle them. Sometimes an ironically accentuated formulation such as „Oh, yeah?“ or a condescending inspection is enough. The aim of this behaviour, regardless of the individual motive, is humiliation in order to appear more important in one’s own position. Employees who allow themselves to be intimidated by this lose their usual sovereignty and are forced into a passive role, collapsing in body language. As a consequence, they lose control of the conversation.

The way out of this situation is primarily to regain one’s own inner strength through an upright, stable outer posture. At the same time, one looks at one’s interlocutor, smiles and continues with the conversation as if the attempt at dominance had not even existed. In most cases, the counterpart recognises the ineffectiveness of his behaviour and allows himself to be led back into a normal conversation.

Further assistance

Not only communication competence is an important aspect for the quality of work of practice teams, but also the quality and functionality of the cooperation of the staff. GPs and specialists who would like to examine and develop their staff in this respect can use the Valetudo Check-up© „Teamwork Medical Practice“ for this purpose. The concept, which can be carried out without the need for an on-site consultant, makes it possible to carry out a professional analysis of the key factors of teamwork. Furthermore, the instrument uses open questions to determine the practice’s strengths and weaknesses as well as suggestions for improvement from the staff’s point of view.

Read more (German)…