June 03, 2010 | | Comments 0
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The Maddeningly Difficult Patient

The maddeningly difficult patient presents a maddeningly difficult challenge —almost daily.

Oops. I said “difficult patient” and I vowed never to use that term. I think it’s much more constructive to talk about “difficult situations” and the “difficult-for-me patient”. The fact is, because patients and families are so anxious during healthcare experiences and so out of their element, many people do not behave at their best. They are not inherently difficult. The situation is difficult for them. (Click here to read more about “The Difficult-for-me Patient”)

Yet, since challenging patients and families produce so much stress for service providers, I am constantly trying to learn about ways to help. Recently, at a large medical group, I ran a focus group with nurses, billing reps, registrars, phlebotomists and others known for dealing with difficult situations well. To help spark sharing and insights, I used behavioral interview questions:

“Tell me in detail about a time you were challenged.”

  • What were the circumstances?
  • What happened exactly?
  • What did they say?
  • What did you say?
  • What were you thinking?
  • What did you do?
  • How did the other person react?
  • Then what did you do?
  • And what were the results?

The energy for sharing these success stories was electric. (Note: You can use these same questions in a staff meeting to engage people in sharing successes and success strategies!) After people shared their stories, we developed a long list of pointers for others on handling difficult situations. Here are a select few:

Four Pointers from Staff Expert at Handling Difficult Situations

  1. It’s impossible to handle a situation well if you think of it as a battle. Your goal needs to be win-win for both parties.
  2. It takes a generous heart to handle challenging people. Deep-breathe and remind yourself, “This isn’t about me,” and show all the more empathy and compassion, because the other person is, after all, stressed or agitated.
  3. You need to know what your options are and feel clear in your own head about what’s negotiable and what isn’t. In many challenging situations, you do everything possible to accommodate the other person and they still aren’t satisfied. In those cases, don’t get into arguments. Instead, hold firm (and here’s the hard part) –in a caring way- without becoming curt, impatient, rigid, or angry.
  4. We all get “triggered” sometimes. If you are losing your composure, don’t be too proud to say that you want to consult another person (e.g. your supervisor or a colleague) who might be better able to address the customer’s issue.

My Favorite Skill: The Caring Broken Record

Getting more concrete, my favorite skill for these situations is The Caring Broken Record. This skill has gotten me out of many jams – without damaging my relationship with the other person. (Try it with your kids!)

What is the Caring Broken Record? Perhaps the customer complains, resists, accuses, or doesn’t want to take no for an answer? If you’ve done all you can responsibly do to accommodate the person and the person still isn’t satisfied or cooperative:

  • Repeat your bottom line message –with lots of heart. Your bottom line message packed with expressions of caring becomes your “caring broken record.”
  • In response to your customer’s resistance or persistence, keep repeating this Broken Record — in a calm way. Don’t address each argument or excuse. Just hold your ground by kindly repeating yourself.

The Benefits

  • You can say hard things and hold your ground in a caring way.
  • The person on the receiving end hears your message clearly.
  • You can remain calm and non-defensive with no regrets later about losing your composure.
  • You can avoid argument and time-consuming debate.
  • You can end the interaction without damaging your relationship.

Click here to see examples of the Caring Broken Record in action.

Also, preview my video on this wonderful skill  and then select the last video in the jukebox.

The challenging patient (or family member or coworker) is only challenging if we feel challenged. The prescription: Be forthcoming with caring and compassion even when the answer might be “no.”

Entry Information

Filed Under: Blog basicsHot topicsImage of nursingLeadership


Wendy Leebov About the Author: Wendy Leebov is a passionate advocate for creating healing environments for patients, families and the entire healthcare team. A mission-driven expert, Leebov provides outcomes-based consulting services, culture change strategies with healthcare organizations, training and tools for enhancing the patient and employee experience. With more than 30 years of experience and skills in communication, training design and delivery, she is known for making hard skills accessible and motivating people to stretch and apply skills which set them apart. Author of 12 books for healthcare, Wendy has produced two groundbreaking video-based skill building systems that educate and empower all staff to deliver the exceptional patient experience consistently by excelling at caring communication. Wendy writes a free monthly e-newsletter - HeartBeat on the Quality Patient Experience - packed with concrete tips and tools for managers who champion the great patient and employee experience. Visit Wendy’s website for more great tips and tools.

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