THE GENERAL APPROACH TO THE DIFFICULT PATIENT - 09/09/11

Doi : 10.1016/S0733-8627(05)70028-6

James Adams, MD, FACEP ^a, Robert Murray, MD ^b

^a Department of Emergency Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (JA)

^b Harvard Affiliated Emergency Medicine Residency, Boston, Massachusetts (RM)

Résumé

The “difficult” patient label and all of its synonyms have been used widely in medicine.^{8 John C., Schwenk T.L., Roi L.D. , et al. Medical care and demographic characteristics of difficult patients 1987 ; 24 : 607-610

Cliquez ici pour aller à la section Références, 13 Maoz B., Antonovsky H., Ziv P. , et al. The family physician and his “nudnik (bothersome) patients”: An exploratory study Isr J Psychiatry Relat Sci 1985 ; 22 : 95-104

Cliquez ici pour aller à la section Références, 17 Shocket B.R. The difficult patient in the general hospital Am Fam Pract 1973 ; 95-99

Cliquez ici pour aller à la section Références, 20 Strauss A. “Shpos.” South Med J 1983 ; 76 : 981-985

Cliquez ici pour aller à la section Références} This label has been used to define patients who are medically challenging, interpersonally difficult, psychiatrically ill, chronically medically ill, or lacking in social support. Medical conditions with little or no likelihood of being cured or alleviated are sometimes especially troubling to physicians.^{9 Klein D., Najman J., Kohrman A.F. , et al. Patient characteristics that elicit negative responses from family physicians J Fam Pract 1982 ; 14 : 881-888

Cliquez ici pour aller à la section Références} Patients who are manipulative or undesirable are often viewed as difficult.^{14 Melling P. How to cope with the manipulative patient Austr Fam Physician 1985 ; 12 : 725-728

Cliquez ici pour aller à la section Références, 15 Papper S. The undesirable patient Journal of Chronic Disease 1970 ; 22 : 777-779 [cross-ref]

Cliquez ici pour aller à la section Références} Previous studies analyzing the phenomenon of the difficult patient have been mainly restricted to primary care and psychiatric settings.^{2 Corney R.H., Strathdee G., Higgs R. , et al. Managing the difficult patient: Practical suggestions from a study day J R Coll Gen Pract 1988 ; 38 : 349-352

Cliquez ici pour aller à la section Références} An understanding of the difficult patient in the emergency department (ED) and of some techniques to minimize these difficulties are essential tools to emergency medicine physicians.

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Plan

THE DIFFICULT PATIENT

Why Difficulty Arises

The Environment

THE EMERGENCY DEPARTMENT ENVIRONMENT

CHALLENGES

Vague Complaints

Emotional/Affective Disorders

Healthy Distance, Caring, and Communicating

Address reprint requests to James Adams, MD, FACEP, Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, e-mail: jgadams@bics.bwh.harvard.edu