ETHICS
ETHICS - Navigating complex patient relationships - Strategies for difficult encounters in clinical practice
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Difficult patient encounters are relatively common in clinical practice. On average a difficult patient-doctor relationship occurs in about 15% of adult patient consultations. Typically, difficult encounters occur in the setting of complex, often chronic medical issues (such as chronic pain, and/or mental illness) that are associated with or worsened by social factors such as poverty, abusive relationships, and addiction. In paediatric practice it is often the parent or guardian who is involved in the difficult encounter. This situation poses an additional ethical dilemma because the child patient is at risk of being refused access to the practice because of the “difficult parent”.
James Groves1 grouped difficult patients’ behaviour into ‘four stereotypes: (1) dependent clingers; (2) entitled demanders; (3) manipulative help-rejectors; and (4) self-destructive deniers.’
Patient, physician, and system factors all contribute to the difficult patient encounter.
Managing the difficult encounter involves actively listening to the patient, identifying the emotion and expressing empathy, exploring different ways of managing the situation, and providing closure by agreeing on a way forward.
The presentation will illustrate difficult patient encounters using case studies and will also cover strategies for managing them.
- Groves JE. Taking care of the hateful patient. New Engl J Med 1978;298(16):883-887.
- Categorisation of the ‘difficult patient’ according to James Groves
- Identification of contributory factors to the difficult patient encounter (patient, physician and system factors)
- Describe tools available for managing the difficult patient encounter
- List the steps to be taken for one of the tools
- Describe issues unique to the difficult paediatric patient encounter.
Dr Di Hawarden
Editor of Current Allergy and Clinical Immunology.
Dr Di Hawarden is the immediate past chairperson of ALLSA. (Allergy Society of South Africa) She has served on the committee since 2001. Dr Hawarden worked at the allergy clinic at Groote Schuur Hospital and Red Cross Children’s Hospital from January 2000 to October 2018. In addition, she had a private practice at UCT Lung Institute, where she saw private adult and paediatric allergy patients. Di is an enthusiastic examiner, convenor and moderator of the Diploma in Allergy run through the CMSA. Together with Professor Weinberg, she is the editor of Current Allergy and Clinical Immunology. (CACI) Di and Dr Shaunagh write the popular ABC of Allergy which appears in each edition of the journal. She has published in local and international journals and writes a section for the South African Medicine Formulary. (SAMF)
Dr Sharon Kling,
Emeritus associate professor in the Department of Paediatrics and Child Health.
Sharon Kling is an emeritus associate professor in the Department of Paediatrics and Child Health and part-time lecturer and project consultant in the Division of Medical Ethics, Faculty of Medicine and Health Sciences (FMHS), Stellenbosch University. She is a member of the Tygerberg Hospital Clinical Ethics Committee, the FMHS Undergraduate Research Ethics Committee, and the Executive Committee of the Allergy Society of South Africa. She is passionate about paediatric ethics and her research interest is clinical ethics committees and consultation.
