Episode 51 Effective Patient Communication – Managing Difficult Patients

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 30 September 2014

⏱️ 67 minutes

🔗️ Recording | iTunes | RSS

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Summary

If you believe that coping with some of the people we deal with in emergency medicine is difficult or impossible, you’re not alone. We all feel this way from time to time. Managing difficult patients can be a challenge to the health care provider and to the entire ED. The hostile aggressive patient, the demanding patient, the know-it-all, the excessively anxious patient, and the incessant complainer, are some of the folks that we need to know how to manage effectively. If we fail to handle these patients appropriately, they may receive suboptimal care, grind patient flow to a halt, and delay care of other patients. If the staff has to deal with a multitude of these patients on a given shift, there’s a sort of swarm-based escalation in frustration and sometimes, unfortunately, a total breakdown of effective patient communication and care. But don't fret. In this one-of-a-kind podcast on effective patient communication and managing difficult patients, Dr. Walter Himmel, Dr. Jean-Pierre Champagne and RN Ann Shook take us through specific strategies, based on both the medical and non-medical literature, on how we can effectively manage these challenging patients. As a bonus, we address the difficult situation of breaking bad news with a simple mnemonic and discuss tips on how to deliver effective discharge instructions to help improve outcomes once your patient leave the ED.

Transcript

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0:00.0	Welcome to part two of our episode on effective patient communication. This time around we're going to be talking about the difficult patient and specific strategies we can use to make their outcome better and to make our lives easier in the emergency department.
0:16.9	We're also going to talk about the difficult situation of breaking bad news, as well as the importance of good discharge instructions.
0:24.6	So without further ado, here's Dr. Walter Himmel, Dr. Jean-Pierre Champagne, and Nurse Anne Shook on effective patient communication and dealing with the difficult patient.
0:45.3	Thank you. and dealing with the difficult patient. Three, two, one. We're going to move on now to the difficult patient. And the first difficult patient I'd like to present is the hostile, aggressive patient.
0:50.3	So here's a case.
0:52.3	A 56-year-old woman has an episode of dizziness followed by
0:56.1	syncope while at work. She's being investigated for, quote, heart issues by her family
1:01.9	physician. She's transported to the ED via EMS and placed in a monitored bed. On exam, she's alert
1:08.4	and oriented, and her vital signs are stable. The ECG is negative.
1:12.6	The nurse does his usual assessment, draws blood work, and places an IV.
1:17.6	The patient's husband arrives in the ED after leaving his workplace approximately 45 minutes later
1:23.6	and presents to the department in an obvious state of anxiousness and near panic.
1:29.8	Upon finding out that his wife has not been assessed by the doctor, he becomes hostile and
1:34.8	aggressive in his body language as well as stating, if someone doesn't look after my wife right
1:40.1	now, there's going to be big problems around here and someone's going to pay.
1:46.9	So physicians are humans.
1:52.6	They may get frustrated, angry, and upset when faced with a particularly difficult patient.
1:58.4	Countertransference, that feeling you get of being totally drained after interviewing a depressed patient for a while, for example, that most of us
2:01.1	learned about on our psych rotations, happens all the time. So it's natural for us to get
2:06.5	frustrated with difficult patients. But there's ways to manage these frustrations that will
2:11.7	enrich our professional lives and prevent your department from coming apart at the seams
2:16.2	and in the long term preventing burnout.
	...

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