Login

Heartsink and other challenging patients

We all have these, but mine would not be yours and vice versa.

The underlying issue is that you feel uncomfortable and that they have unrealistic expectations.

The key to resolving this is for you to understand more fully where they are coming from.

For a start, maybe they match one of the following four stereotypes?

The Dependent Clinger

Someone who comes back over and over again, for something minor or self-limiting which others would not need to see you about.

Their requests are repeated - referral / prescriptions / advice. "My shoulder is better now Doctor, but it's my stomach. Better be safe than sorry, don't you agree Doctor?" Over-appreciative; may give praise, often gifts.

Some solutions:

This patient needs:

The Doctor needs:

  • To recognise how she feels and the emotional cost of this patient.
  • Housekeeping - the need to avoid carrying the frustration over to the next patient! See - How to say it .

The Entitled Demander

Someone who "knows their rights" and believes that their GP is there to meet their every need, giving a concrete token of their worth [a scrip or a referral] in every case.

They progressively wear down their GP until he / she can't stand the prospect of seeing them, and they risk a serious diagnosis being missed because of the reaction they engender.

Some solutions:

This patient needs:

  • To understand what is being offered by their GP and what is not. See -Where is the line?
  • To understand what is being offered by their GP and what is not. See -Where is the line?
  • To be helped to understand that their problems are self-limiting, and when to seek advice. See - How to say it
  • Encouragement to help themselves. See - How to say it
  • Help to understand that they own the problem. See - How to say it

The Doctor needs:

  • To recognise how she feels and the emotional cost of this patient.
  • To be very clear about what they are providing.
  • Housekeeping - the need to avoid carrying the frustration over to the next patient! See - How to say it .

The Help-Rejecter

Someone who is never satisfied that the Doctor has done as much as possible, and cultivates a passive child-parent relationship with the GP.

As soon as one problem is sorted out, they attend with a new one; "Better to be safe than sorry." Because their approach to their GP is fundamentally dysfunctional, this deep-seated behaviour takes time and much patience to unravel.

Some solutions:

This patient needs:

  • Firm boundary setting and absolute clarity about agreed aims and the routes to be taken to achieve them.

The Doctor needs:

  • Mainly to recognise what is going on here.
  • It is relatively simple to diagnose the problem once you're aware of its existence. Moving towards a more reasonable and productive Dr - Patient relationship will be more complex and depends on the personalities involved. The overall key is to avoid being pressured into a parental role which fosters dependency, and to cultivate an adult-to-adult relationship. This means consistently involving the patient in thoughts, actions and decisions concerning their own treatment so that they take as much responsibility for themselves as they can reasonably handle. If the constant attendance is attention-seeking for reasons which turn out to be non-medical, it might be useful to enlist the help of someone skilled in the area of the underlying problem. Please see How to say it for further suggestions.

The Self-Destructive Denier

Someone who never accepts what the Doctor advises, but continues with the same behaviour which is usually an addiction or life-style which threatens their health but which they seem unable to break out of. This again is a very deep-seated dysfunction which may have unresolved issues of grief or even abuse from childhood.

It is therefore vital that a non-confrontational approach is taken, involving support and understanding while still not encouraging the destructive behaviour. The fact that they are attending at all needs to be seen as a wish to change.

Some solutions:

This patient needs:

  • To accept the effect their behaviour is having on their long-term health.
  • To accept that they are in control of their behaviour.
  • To accept that their behaviour needs to change if their health is to improve.
  • A well-planned strategy to ditch the previous cycle of behaviour and implement a more productively healthy lifestyle.

The Doctor needs:

  • To be careful not to alienate the patient, but to ensure they are seen as an ally - although one who will not collude with the patient's inappropriate behaviour. As self-destructive deniers can be highly manipulative, it may be useful to share useful practice with colleagues or those who specialise in addictive behaviours. See How to say it for further suggestions.
  • Funding
  • Gloucestershire LMC Logo
  • Gloucestershire GPSH is funded by Gloucestershire LMC.
  • GPSH was originally commissioned
    by the Clinician Support Service
    and its contents are strictly copyright.
  • Credits
  • Project Director and original idea: Roger Crabtree
  • Research and Text: Lynn Collins
  • Website Design: Andreas Wichter and Anne Hicks
  • Website Construction and Maintenance: Careers Systems
  • Original Painting: Judith Milne