The "difficult" patient reconceived: an expanded moral mandate for clinical ethics.
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TLDR
It is argued that the phenomenon of patients being deemed “difficult” can be better explained as a response to problematic interactions related to health care delivery, and there is an ethical obligation to address this perception of harm.Abstract:
Between 15 and 60% of patients are considered "difficult" by their treating physicians. Patient psychiatric pathology is the conventional explanation for why patients are deemed "difficult." But the prevalence of the problem suggests the possibility of a less pathological cause. I argue that the phenomenon can be better explained as a response to problematic interactions related to health care delivery. If there are grounds to reconceive the "difficult" patient as reacting to the perception of ill treatment, then there is an ethical obligation to address this perception of harm. Resolution of such conflicts currently lies with the provider and patient. But the ethical stakes place these conflicts into the province of the ethics consult service. As the resource for addressing ethical dilemmas, there is a moral mandate to offer assistance in the resolution of these ethically charged conflicts that is no less pressing than the more familiar terrain of clinical ethics consultation.read more
Citations
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Patients' participation in decision-making in the medical field - ‘projectification’ of patients in a neoliberal framed healthcare system
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The Stanford Prison Experiment: Implications for the Care of the "Difficult" Patient.
So L. Onishi,Randy S. Hebert +1 more
TL;DR: Clinicians who are aware of the multilevel impact of these various environments on the behavior of patients are better equipped to understand, address, and hopefully even prevent difficult patient encounters.
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Sickle Cell Disease and the “Difficult Patient” Conundrum
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References
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Journal ArticleDOI
Ethics consultation in United States hospitals: a national survey.
TL;DR: Ethics consultation services (ECSs) were found in 81% of all general hospitals in the U.S., and in 100% of hospitals with more than 400 beds, and consultation practices varied widely both within and between ECSs.
Journal ArticleDOI
The difficult patient: Prevalence, psychopathology, and functional impairment
Steven R. Hahn,Steven R. Hahn,Kurt Kroenke,Robert L. Spitzer,David S. Brody,Janet B. W. Williams,Mark Linzer,Frank V. deGruy +7 more
TL;DR: Difficult patients are prevalent in primary care settings and have more psychiatric disorders, functional impairment, health care utilization, and dissatisfaction with care, whereas demographic characteristics and physical illnesses were not associated with difficulty.
Journal ArticleDOI
Difficult patient encounters in the ambulatory clinic: Clinical predictors and Outcomes
Jeffrey L. Jackson,Kurt Kroenke +1 more
TL;DR: Patients presenting with physical symptoms who are perceived as difficult are more likely to have a depressive or anxiety disorder, poorer functional status, unmet expectations, reduced satisfaction, and greater use of health care services.
Book
Difficult Conversations: How to Discuss What Matters Most
TL;DR: In this paper, the authors explore each other's stories and explore each others' stories to find out what's at stake waht's your purpose, when to raise it and when to let go.
Journal ArticleDOI
The difficult doctor-patient relationship: Somatization, personality and psychopathology
TL;DR: The Difficult Doctor-Patient Relationship Questionnaire (DDPRQ), composed of 30 Likert items, completed by physicians after encounters with patients, was developed and was shown to be a reliable, practical instrument.