Dealing with Difficult Patients (ANSWERED)

QUESTION

Write an application paper based on the following scenario and how you would convince the parents that a head CT is unnecessary: Review, apply, and cite content from the three required readings to discuss how you would communicate and interact with the parents:

A 16 year-old male was playing football and was tackled, sustaining a head injury. The parents bring the patient to the emergency department and demand a CT scan “to make sure he does not have a concussion.” The patient is awake and alert, behaving normally, and has a normal physical exam. He does not meet any established criteria for head CT. The parents, however, are insistent upon having a CT of the patient’s head. They are on the phone with their pediatrician demanding that he force the emergency department to do a CT and they report that they Googled head injury and “he might have a serious head injury.”

It is most important to “teach to the level your learners”. This helps to avoid cognitive overload and helps to improve understanding. Be sure to communicate at a level your patients can understand. Be careful with the overuse of medical and scientific terminologies and advanced vocabulary. Remember the goal is to change patient behavior toward improved health, not to display that you know everything about the medical condition. Patient education is the process of influencing patient behavior & attitude, knowledge, and skill required to maintain and improve health. It considers the patient holistically, with all needs and concerns, sets goals with the patient for desired outcomes, and follows up for assessing the extent to which patient goals were achieved. Transfer of medical knowledge that takes place with patient teaching does NOT ensure behavioral change.

ANSWER

Introduction

Any patient in a hospital setting relationship, as a matter of law, is entitled to care provided in a professional and reasonable manner. However, some patients or family members sometimes prove difficult to handle. Patients or family members who stir up emotional reactions in the health care setup tend to be labeled “difficult.” These might be the ones who question every suggestion or demand that the doctors provide something inappropriate, like unjustifiable procedure, letter, or drugs (Fiester, 2015). Whenever such interaction happens, care professionals can expect frustration, aggravation, and, often, anger, and the outcomes are prone to be unsatisfactory for both the care professional and the patient. The doctor usually has to decide what to do or say in response to a difficult patient. Therefore, developing useful strategies for dealing with difficult patients or guardians is vital. The best way to handle them is to confront their behaviors directly (Schuermeyer et al., 2017). Often, they do not understand the job and responsibilities of a doctor, and maybe with some education, they can learn something. The current paper presents how you would convince the parents that a head CT scan is unnecessary in the given scenario.

Discussion

The case scenario involves a 16-year-old male brought to the emergency room with a head injury. The patient was playing football and was tackled, sustaining the injury. The parents bring him to the emergency department and demand a CT scan “to ensure he does not have a concussion.” The patient is awake and alert, behaving normally, and has a normal physical examination. He does not meet any established criteria for a head CT scan. The parents, however, insist on having a CT scan of the patient’s head. They are on the phone with their pediatrician, demanding that he force the emergency department to do a CT scan, and they report that they Googled head injury and “he might have a serious head injury.”

The illustrative case above is an example of a patient situation that may be deemed difficult. Most practices include such patients, with a prevalence of about 15%. While most physicians enter medicine to cure diseases and solve medical problems, they do not expect to encounter patients who come to the hospital with early research that they have not yet reviewed (Schuermeyer et al., 2017). Most of these patients get the information on the internet and request a specific test or medication that may not be medically justified or cost-effective. This case may be frustrating to the physicians and may suppose that patients do not trust them to treat optimally or diagnose appropriately. Furthermore, discussing such information with the patients is time-consuming, causing others in the queue to wait longer and contributing to the stress of dealing with overbooked appointments. In such a scenario, it would be appropriate to teach the patient’s parents to avoid frustration, aggravation, and anger, to improve their understanding and leave them satisfied with the care that will be accorded the patient. Approaching the boy’s parents as an opening to educating them may lead to a more trusting relationship whereby they may be open to doctor’s direction and more likely stick to a proposed treatment plan.

First, the physician should adopt a positive attitude towards discussing the contributions of Google and other internet sources. Here, the physicians should explain to the parents that not all internet sites, including Google, are reliable sources of medical information. Furthermore, he should explain that while some may be reliable, they cannot be applied just like that without appropriate medical examinations to warrant their application or use (Fiester, 2015). Here, the physician will be trying to acknowledge the effects of the internet information on the parents rather than denying them and ignoring the potential impact on treatment. Secondly, the physician should encourage the patient and his parents to take active roles in maintaining health. Active roles, in this context, involve adhering to a suggested treatment plan.

Thirdly, the physician should acknowledge the parents’ concerns and fears (Haas et al., 2005). From the scenario, the parents fear that their son might have suffered a concussion. However, since the medical examination does not indicate a concussion, the physician should use this information to calm them down and relieve their anxiety. The physician can further explain the symptoms of a concussion and other danger signs that may warrant a CT scan. Patients and family members often become “difficult” or make unrealistic or unnecessary demands due to anxiety and fear. Patients often fear or worry that a critical diagnosis or treatment may be overlooked. However, once these fears are addressed, they tend to be reasonably realistic. The physician may also involve the family pediatrician to assist in the education.

Another most important thing is that the physician should not try to be defensive. Consumers are gaining self-efficacy and autonomy, and health care professionals are encouraged to create ways to integrate this into the care services they offer. For instance, research is underway on how internet-based interactions can help in patient decision-making for screening colorectal cancer. Patients can utilize an online tool at home to educate themselves about screening choices and would be in a comfortable and knowledgeable position to discuss the options with their care providers (Schuermeyer et al., 2017). The physician can approach the parents by telling them, “I can see how worried you are about your son having suffered a concussion, and I want to help you. It is clear to me that you know a lot about healthcare, and I appreciate your engagement in your health.” Here, collaborating with the parents can diffuse anger.

Most importantly, the physician should go ahead and explain to the parents the pros and cons of a CT scan. Having explained to the parents that the result of their son’s medical examination does not point to a necessity of a CT scan, it would be now proper to educate them about the importance of reducing unnecessary CT scans of the head. CT scan is a decisive imaging study in diagnosing and treating head injuries. Nevertheless, its haphazard use can negatively affect patients and the entire health care system (Elmoheen et al., 2021). According to Masood et al. (2020), over 45% of head CT scans requested for minor head injuries in the ED were not appropriately indicated according to the WHO guidelines. The leading cause was a lack of knowledge of established criteria for head CT scans and misinformation. The physician should explain this information to the patient’s parents in simple language. Also, he should explain to them the established criteria for head CT scans for minor injuries and assure them that their son does not meet these criteria. Following this approach, the parents would most likely be ready to long with the treatment plan that the physician will suggest.

Conclusion

The illustrative case above is an example of a patient situation that may be deemed difficult. To approach this situation, the physician should adopt a positive attitude towards discussing the contributions of Google and encourage the patient and his parents to take active roles in maintaining health. Active roles, in this context, involve adhering to a suggested treatment plan. He should then acknowledge the parents’ concerns and fears and try to address them. Lastly, the physician should explain to the parents the negative repercussions of indiscriminate head CT scan applications for patients and the entire health care system.

References

Elmoheen, A., Salem, W., & Bashir, K. (2021). Reducing unnecessary CT scan of the head for minor paediatric head injuries at the emergency department. BMJ open quality, 10(1), e000973. https://doi.org/10.1136%2Fbmjoq-2020-000973

Fiester, A. M. (2015). What mediators can teach physicians about managing ‘difficult’patients. The American Journal of Medicine, 128(3), 215-216. https://www.amjmed.com/issue/S0002-9343(14)X0005-7

Haas, L. J., Leiser, J., Magill, M. K., & Sanyer, O. N. (2005). Management of the difficult patient. American family physician, 72(10), 2063-2068. https://www.aafp.org/pubs/afp/issues/2005/1115/p2063.html

Masood, S., Woolner, V., Yoon, J. H., & Chartier, L. B. (2020). Checklist for Head Injury Management Evaluation Study (CHIMES): a quality improvement initiative to reduce imaging utilisation for head injuries in the emergency department. BMJ open quality, 9(1), e000811. doi:10.1136/bmjoq-2019-000811

Schuermeyer, I. N., Sieke, E., Dickstein, L., Falcone, T., & Franco, K. (2017). Patients with challenging behaviors: Communication strategies. Cleve Clin J Med, 84(7), 535-542. doi:10.3949/ccjm.84a.15130