A family physician, Dr Oluwafolajimi Senjobi, said that increasingly, attending to the health needs of Nigerian patients is becoming more difficult because a good doctor-patient relationship, has been hampered by economic meltdown, high cost of medication, overhead costs on health deliverables and doctors’s burnout.
Dr Senjobi, in his lecture entitled “Managing Difficult Patients,” a Continue Medical Education series by the Nigerian Medical Association, Oyo State branch, said difficult patients usually arise because of many factors, including patient factors, health system factors, physician factors, and situational factors.
According to him, difficult patients are usually demanding, noncompliant, dependent, and exhibiting traits like being violent, argumentative, litigious, drug-seeking, angry, non-paying, complaining, and even seductive.
“There are different classifications of difficult patients. For instance, the manipulative help-rejecters continually return to the clinic to report that treatment failed. The self-destructive deniers whilst suffering from a potentially serious condition will make no effort to alter their self-destructive behaviour, eliciting and then frustrating medical efforts to help them.
“Entitled demanders are also inexhaustibly needy, but rather than using thanks and flattery, will use intimidation, devaluation, and guilt against the doctor, frequently complaining when every request is not met.”
Dr Senjobi, however, added that a considerable number of patients that are labelled difficult actually have mood disorders, anxiety disorders, and borderline personality disorders or who have become dependent on prescription drugs or are substance abusers.
“We should have an index of suspicion in our mind that they may have some form of mood disorders, anxiety disorders, or bipolar affective disorders. It may not be full-blown disorders; it may be in the form of traits. The person is not yet dysfunctional. The person is still functioning,” he added.
The medical expert emphasised the need for medical doctors to be able to identify difficult patients when they come to the clinic and appropriately manage them.
“When confronted with a difficult patient, there are some immediate steps to take. Hear them out, empathise with them, acknowledge and apologise for the inconveniences, respond appropriately, take responsibility for your action, and thank your patient for bearing with you.
“A clinician can only practice for so long before encountering difficult or frustrating patients. However, understanding the common sources of difficult or frustrating behaviour and implementing effective strategies can improve clinicians’ satisfaction with their practice and professional lives, as well as improve outcomes for the patients involved.”
Dr Senjobi, in stemming increasing cases of difficult patients in Nigerian hospitals, urged the government to prioritise the interests of patients and pass legislation back for reimbursing services by healthcare providers.
“Just as we have the patient health bill to ensure patients rights, including access to medications, there should be laws to ensure that physicians too get reimbursed for their services so that there will be equity,” he said.
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