Difficult Relationships: Patients, Providers, and Systems

Abstract

Perspectives on difficult patients have evolved substantially over the years; this paper exams some of the recent developments and trends in literature on this topic. Conflict between providers and their patients was once seen as the fault of the patient; more recently, models have evolved to look at how provider behavior and attitudes as well as systems of care can play a significant role in creating—and, hopefully—defusing such conflict. Conflicts may be informal or escalate to formal complaints; monitoring and remediating both can play a significant role in mitigating exposure to malpractice litigation. Conflicts, complaints, and litigation can have significant impact on clinical operations and teams. Conflicts between providers and patients are now recognized as a dynamic and interpersonal process rather than the fault of the patient. Verbal de-escalation, or variations thereof, is seen more and more as a “best practice” approach to managing conflict and complaints in healthcare and other settings.