Sunday, June 24, 2012

How to deal with the "difficult patient" in the OSCE exam

So what is the "difficult patient"?

The "difficult patient" are those whose agenda is strongly in conflict with the treating practitioner, and the situation may potentially create a lot of tension in the consult.  Examples are:
  1. The inappropriately drug seeking patient
  2. The patient who is asking for an inappropriate medical certificate
  3. The non compliant patient
  4. The angry and demanding patient
  5. The manipulative patient
  6. The patient with a personality disorder who is very demanding
  7. The unfit driver who insists on driving
  8. Others....
So how does one approach this?.....  Not easy but there is a strategy that can be helpful here.  It is what I call the "Validate and Challenge Technique".

If you are faced with one of the above scenarios in the exam, you can start with validating the person's point of view and feelings first, and once acknowledged, you can then set some clear boundaries on what you can or cannot do.

Alternatively, you can challenge the person without the validation.  Challenge without validation may draw you into the escalation trap, and it can become very heated.

The trick is to get the balance right between the "validation" and the "challenge".  The validation helps to acknowledge the person's feelings and agendas, and the challenge helps to set clear boundaries on what you can or cannot do.   In the case of the inappropriately drug seeking person, this is one way to "validate and challenge".

I can see that you are upset and disappointed.  It is normal to feel that way when you need something from a Doctor, and then the Doctor is unable to give you that to you.  (This is the validating part)

And at the same time.... (Avoid the word "but" here.  "But" will negate your validation and acknowledgment)

due to my obligation to first do no harm and other legalities, I can't give you these medications right now.  We can explore other options.

As a health professional, we need to deliver this in a non judging and compassionate way.  That will give you the best possible outcome.

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