Family physicians commonly find themselves in difficult patient encounters that can result in dissatisfaction for the patient and physician. Successful navigation of these encounters includes recognizing common physician factors, such as systemic pressures, interpersonal communication, and situational issues. The practice of labeling patient types can lead to disparities in care and patient harm and should be avoided. When physicians recognize that they are in a difficult patient encounter, simple mindfulness approaches, such as the Name It to Tame It and CALMER approaches, can improve outcomes. CALMER approaches help physicians acknowledge which situations they can control, alter their thoughts about the situation, and tolerate uncertainty. Physicians working with patients to create a therapeutic bond can focus the encounter to understand the situation that the patient is experiencing and work to recognize and acknowledge strong emotions that are nonproductive. Negotiating an agenda can help manage expectations of what can reasonably be done during each visit. Supporting patients by validating their symptoms and helping them embrace uncertainty can enable them to take control of their diagnosis and focus on managing chronic conditions rather than curing them. Motivational interviewing is a useful tool to help patients take ownership of their illnesses and therapeutic goals. Self-care through reflection groups or personal coaching or counseling can help physicians feel supported and avoid burnout.
Difficult patient encounters are common in family medicine. Physicians who experience frequent difficult clinical encounters are more likely to experience low job satisfaction and burnout than those who do not.1,2
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendations | Evidence rating | Comments |
|---|---|---|
| Avoid labeling patients during difficult encounters and instead assess for contributing factors such as underlying substance use, trauma, chronic pain, and psychological conditions.2,16,17,19,20,22,27 | C | Expert opinion and systematic review |
| Consider using mindfulness techniques such as Name It to Tame It or the CALMER approach to improve communications.33,34,39,40 | C | Expert opinion in absence of clinical trials |
| Incorporate motivational interviewing as a tool when working with patients. Motivational interviewing improves the therapeutic alliance with patients and can effectively influence behavioral change.41–45 | B | Limited-quality, patient-oriented evidence and expert opinion |
| Use communication strategies of active listening, validating emotions, exploring alternative solutions, and providing closure when in emotionally charged encounters.21,47–52 | C | Expert opinion in absence of clinical trials |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
Successfully navigating difficult patient encounters requires understanding and identifying physician and patient factors and external conditions that may apply to any clinical situation.3 Physicians bring their own experiences, biases, values, strengths, and weaknesses to all patient encounters. Patients bring their own personalities, values, complex medical needs, varying levels of health literacy, and communication styles to their interactions with physicians.4,5 Both patients and physicians are affected by conditions in the medical system that are beyond their control.6
Read the full article
Get immediate access, anytime, anywhere.
Choose a single article, issue, or full-access subscription.
Earn up to 14 CME credits per issue.
