ALTHOUGH managing difficult or frustrating patients requires experience, clinicians can enhance their professional lives and job satisfaction while also improving patient outcomes by identifying common causes of challenging behaviour and implementing effective strategies.
Dr Folajimi Senjobi, a family medicine specialist at University College Hospital, Ibadan, made this assertion during the Oyo State Nigerian Medical Association (NMA) September continuing medical education series titled ‘Management of Difficult and Angry Patients.’
According to Senjobi, 15 to 20 percent of patients receiving medical care are thought to be difficult but the term ‘difficult patient’ refers more to the doctor’s response than to specific criteria of difficulty and does not denote a distinct diagnostic category.
He stated that the traits of difficult patients’ behaviours typically include drug-seeking, violent, litigious, seductive, angry, non-paying, manipulative, needy, argumentative, and persistently complaining.
‘For example, there are entitled demanders who are inexhaustibly needy. Instead of expressing gratitude or using flattery, they resort to intimidation, devaluation, and guilt toward the doctor managing their care. Then, there are dependent clingers who are excessively reliant on the doctor, desperate for reassurance, and who repeatedly return with a new array of symptoms.
‘Also, we encounter manipulative health rejectors who repeatedly return to your clinic, claiming that your treatment has failed. Whenever one symptom is alleviated, it is quickly replaced by another.
‘A considerable number of patients labelled as difficult may actually meet the DSM criteria for mood disorders, anxiety disorders, and/or borderline personality disorder. Others include patients who have become dependent on prescription drugs, those with substance abuse issues, and patients who frequently doctor shop.’
Dr. Senjobi, however, listed factors that influence difficult patient encounters with doctors, including physicians’ poor communication skills, low job satisfaction, time pressure during consultations, and physicians’ personal biases.
Other factors include changes in healthcare financing policies, past incidents of medical errors or mistrust, patients’ personality types, unmet patient expectations, language and literacy barriers, medical uncertainty, as well as physical, mental, and emotional abuse.
According to Dr Senjobi, the treatment for a difficult or frustrating patient should be based on a careful and thorough assessment of their physical condition.
He warned that strategies such as ignoring the problem, accusing the patient of being difficult, attempting to solve the issue solely with psychopharmacology, or telling the patient that nothing is wrong will be counterproductive in managing difficult patients.
Senjobi therefore recommended adopting the patient-centred clinical method of care to explore patient problems and to guide the best approach for defining and deciding on the management plan for both the disease and the illness experience, in collaboration with the patient.
Chairman of the Association of Medical Doctors of Oyo State, Dr Muyiwa Ajanaku, said, ‘This presentation is timely and relevant because it equips us with practical strategies to handle challenging patient interactions with professionalism, empathy, and patience. It also reminds us that while medical knowledge is indispensable, communication skills and emotional intelligence are equally critical tools in clinical practice.’
Dr Akin Sodipo, the chairman of the lecture, emphasized that doctors’ documentation of medical cases must be thorough due to increasing litigation and demands on medical practitioners in this era.
In his remarks, Dr Happy Adedapo, the NMA chairman, urged health practitioners to master the skill of handling difficult or frustrating patients to improve healthcare delivery.