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December, 2010

Voices From the Field: How We Deal With Difficult Patients

By Christie Bondurant

In order to help you to both enhance your practice and increase your bottom line, Dynamic Chiropractic PracticeINSIGHTS asks practicing chiropractors, like you, for ideas and solutions that have been tested in real-world environments. In this issue, we asked: "Which kinds of patients are the most difficult to work with? How do you deal with them?"

The Know-It-All

According to doctors, the most commonly reported type of person who is difficult to work thinks they are better than the doctor, and therefore are uninterested in most, if not all, of the doctor's recommendations. Dr. Stephen Savoie of Clermont, Fla., characterizes this type of difficult patient as the one "who wants to be the doctor."

"They don't want to follow treatment recommendations and want to set their own schedule," Savoie said. "Typically they do not improve and of course, it is the doctor's fault. When I get one of these patients, I sit them down and have a frank discussion about the need to follow 'my' recommendations if they truly want to improve their health.

"If they absolutely refuse to be compliant, I tell them that to continue (patient visits) would be a waste of my time and their money, and they should seek care from another provider."

Much like the patient who wants to be the doctor, the problem patient for Dr. Brian Blower of Freeport, Bahamas, knows best - at least in their own mind.

"Perhaps the most difficult patients are those that are looking for relief of their painful symptoms, but are locked onto the pain and uninterested in what you may have to say or do about its cause," Blower said. "This type of non-compliant patient does what he always does, but expects something different (to happen). If he doesn't get it, he degrades you and your care as being worthless. We call this type of person a 'Bayard', which means one that goes confidently along convinced by his own ignorance."

Dr. Eugen Roth of Benalmadena, Spain, also has coined a name for the difficult patient: the "bully" patient. Roth characterizes the types of demands that you can expect from a bully: "'Crack my neck on this side, now that side. The other chiropractor did this, so do it too. Now crack my lower back, now the other side. Do that standing one.' "

Roth's simple solution: "Refer them to the physio!"

While many respondents stated it was best to end the relationship with the difficult patient, Dr. Richard Hargreaves of Bellingham, Wash., chooses to win over his "know-it-all" patient.

One of the more difficult types is "the person who perceives they are 'fit' simply because they go to the gym on a 'regular' basis and now see their body to be requiring only a 'couple of treatments' to be 'fixed.' However, this person usually has overestimated their physical condition and capabilities," Hargreaves said.

"This is highlighted during the initial examination and strength testing, which shows a history of unbalanced and misdirected training which is the result of reading a book, going online, or being trained by a 'trainer', who knows zero about the spine, posture, and carriage.

"How do you deal with them? Repeatedly, but gently and clearly, give them doses of reality regarding the true physical condition of their joints and connective tissues. Some of my best patients are these people who [eventually] come around to do honor to their health."

The Non-Committer

Much like the patient who thinks they know best, the patient who is not committed to their health will not follow the doctor's plan of care. Dr. Ron Waxman of Illinois feels that the best solution when dealing with patients who won't commit to his care recommendations is to let them go.

"The patient who is not committed to getting well (is) therefore not going to comply with your care program," Waxman said. "I look them in the eyes and let them know that they will not get well and they should stop coming into the office. I am willing to let them go without hesitation."

But while some doctors have little to no tolerance for troublesome patients, Dr. Jared Van Anne of St. Louis gives more allowance for potential improvement.

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