Know Thyself First When Addressing the ‘Difficult’ Patient

LAS VEGAS—Understanding why some patients can be more “difficult” than others can involve understanding personality differences. “Who are the difficult patients who are not doing well, who are taking a lot of your time? One of the reasons for why things may not be going well is that you don’t fully appreciate the personality or temperament of that patient,” said Michael R. Clark, MD, MPH, MBA, of Johns Hopkins University School of Medicine in Baltimore, Maryland to PAINWeek 2014 attendees.

Of personality traits, understanding the “introversion/extraversion” set is particularly important for easing clinical interactions and improving patient compliance. “Some people are more outgoing, more dramatic, more emotion-expressing and others are introverted, shy and reserved,” he said.

Providers need to develop strategies for dealing with difficult patients “without getting caught up in labeling people as having a personality disorder, in cases when it’s just a matter of understanding what personality traits they possess and what strengths and weaknesses are, of those personality traits,” he explained.

How you approach treatment adherence can’t be a cookie-cutter affair for different patients because noncompliance could be rooted in different personality traits. “A patient who is care-free, happy go-lucky is not always the best about taking their medications on a day-in, day-out fashion,” he explained. “If they feel good, they don’t take it. On the other end of the spectrum, the obsessional patient worries about side effects and can torture you with questions about toxicity and side-effects, and get paralyzed by their own worry.”

Consider the “benign example” of the obsessional introvert who is very details-focused, he said. “It’s not good or bad to be an obsessional introvert,” he noted. “You might be a fantastic accountant but not a very good car salesman. If somebody’s asking you to be a car salesman, that’s going to generate distress and poor performance. But if you notice he loves numbers and pays attention to detail, well, that’s the guy you want keeping books in the back office.”

It’s much the same with the pain patient, Dr. Clark said. “You want the patient to do well, and when it’s not going well, you have to figure out why. If it’s because of their personality traits, you can change how you interact, and change how the encounters go.”

A patient who is an obsessional introvert “wants to know as much as possible about their care,” he said. “They’re constantly calling the office to ask for more information, asking to speak with the doctor or nurse practitioner. What’s really driving that behavior is that they are not spending enough time with their clinicians, and they don’t have a good method for feeling calm and reassured. If you understand that person’s personality, then that might be the patient you give scientific articles to read, or spend more time educating.”

It is also important for providers to consider their own personality, and how it affects relationships with patients. “All of us are people,” Dr. Clark said. “We have our own strengths and weaknesses. If we are not careful and self-aware as clinicians, our own vulnerabilities can be provoked and we won’t be as effective.”

This article originally appeared on MPR