Managing difficult interactions with patients in neurology practices

Abstract

At some point in their careers, most neurologists encounter patients who they find difficult to help.1,2 This experience may arise as a natural reaction to the challenging diagnostic and therapeutic work that so often is a part of work in the clinical neurosciences. Reports of the physician's reactions to difficult patient encounters appear infrequently in the neurology literature but, when offered, are informative and useful.3 Their publication cuts through the sense of being the only one to face such difficult experiences and provides an opportunity to learn from them both personally and in discussion with colleagues. Other patients are experienced as difficult because the neuropsychiatric sequelae of their neurologic conditions, comorbid psychiatric problems, and/or other challenging behaviors provoke strong reactions in the neurologist and his or her staff. Physician reactions in these encounters run the gamut of emotions, but frequently include aversion, anxiety, hopelessness, and anger, and may sometimes even include feelings of malice.4 These kinds of reactions to patients, and sometimes to their caregivers, complicate and can compromise one's ability to provide neurologic care.1,2,5 In the midst of a strong negative reaction to a difficult encounter with a patient or caregiver, one may be tempted to consider dismissing that patient from one's practice. There are circumstances in which such dismissals of patients from neurologic practices are necessary.1 However, patient dismissals are logistically complicated, stress and strain an already damaged physician–patient relationship, and may result in legal and regulatory penalties for the physician if done improperly. Most importantly, the dismissal itself is rarely in the patient's best interest: it fails to address the cause of the patient's behaviors, results in the transfer of a highly upset patient to an entirely unsuspecting or unprepared colleague, and almost ensures that the …