Dealing With Difficult Patients

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Dealing With Difficult Patients

• Ali R. Rahimi,MD,FACP,AGSF
• Professor of Medicine
• Mercer University School of Medicine
• Clinical Professor
• University of Georgia School of Pharmacy

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1. ES

• 78 years old
• PMH HTN, GERD, PVD, OA, CAD, incontinence, and
  Alzheimer's

• Husband is overbearing
• She is forgetful
• Husband gives her as much medicine as he thinks
  is necessary (digoxin)
• Patient-Caregiver Relationship

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2. TH

• 94 years old
• PMH dementia, Alzheimers, and osteoarthritis

• Always wants free medications
• Daughter never comes with her
• Caregivers knowledge

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3. KY

• 73 years old
• PMH HTN, osteoporosis, hypothyroidism, frontal
  lobe dementia, Picks disease

• Husband is in denial about wifes Alzheimers
  wife has a PhD
• Husband does not believe in taking medications

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4. CC

• 75 years old
• PMH diabetes, COPD, HTN, CVA, leg edema,
  dyslipidemia, and urinary incontinence

• He has no dementia
• Breakdown of wife, she is never there
• Multiple exacerbations of diseases due to lack of
  communication

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Common Characteristics

• Non- adherence with medications
• Family
• Personality
• Knowledge
• Disease

• Communication
• Inflexibility
• Depressed patient
• Doctor

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Non-compliant - Usually fail to follow treatment
regimen

• Fail to take their medications or follow care
  instructions
• Fail to make follow up appointments
• Fail to even fill their prescriptions

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Family Everyone is a doctor

• They arent even family
• They know more than you
• They contradict the patient
• They bring in their own problems

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Personality

• Trust
• Narcissistic
• Lying
• Demanding
• Verbally rude
• Violence/aggressive behavior

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Knowledge

• Is it a bad thing?
• Opinions
• Internet

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Other problems

• Language barrier
• Chronic disease
• Inflexibility
• Depressed

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Solutions

• Recognizing why they are difficult
• Have a thorough understanding of the patients and
  their problems
• Gain trust of the patient
• Dont downplay the seriousness of the complaints

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Solutions

• Dont try to tackle patients problems when
  youre tired or preoccupied
• It might be you, you might have to change
• You may need help with someone
• You can always say NO