Managing Difficult Encounters
R. Gregory R. Lande, DO, COL (Ret.), FACN, FAOAAM
Difficult doctor-patient relationships are a recognized aspect of modern healthcare, but the actual incidence, risk factors, ethical issues, and management strategies are less well-known. The author queried PubMed, ScienceDirect, and the Education Resources Information Center. The inclusion criteria consisted of the free-text terms “difficult patient” and “difficult client” and the Medical Subject Heading terms “patient participation” and “professional-patient relations” with searches further refined by focusing on adults, management, screening, and incidence among review and research articles published in academic journals in English. The author excluded articles focused on children, adolescents, and anger management. This study condenses a body of research spanning two decades and can help clinicians understand factors that contribute to difficult encounters, employ simple screening instruments, and implement management approaches that can minimize difficult encounters and maximize their successful resolutions. Based on the collected evidence, most doctor-patient relationships are trouble-free, but some, ranging between 10% and 20%, are dominated by difficulties of varying degrees and types.
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