The "Difficult" Inpatient, a Qualitative Study of Physician Perspectives. J Gen Intern Med 2024 Aug;39(10):1858-1869
Date
05/21/2024Pubmed ID
38769258Pubmed Central ID
PMC11281999DOI
10.1007/s11606-024-08802-xScopus ID
2-s2.0-85193721604 (requires institutional sign-in at Scopus site)Abstract
BACKGROUND: Previous studies exploring difficult inpatients have mostly focused on psychiatric inpatients.
OBJECTIVE: To explore the characteristics of difficult medicine inpatients.
DESIGN: Qualitative study using focus groups and semi-structured interviews. Transcripts were recorded, transcribed, and coded (MAXQDA) using thematic content analysis.
PARTICIPANTS: Medicine inpatient providers at a tertiary care facility.
KEY RESULTS: Our sample consisted of 28 providers (6 hospitalists, 10 medicine attendings, 6 medicine residents, and 6 interns). Theme 1: Provider experience: Difficult inpatients were time-consuming and evoked emotional responses including frustration and dysphoria. Theme 2: Patient characteristics: Included having personality disorders or mental health issues, being uncooperative, manipulative, angry, demanding, threatening, or distrustful. Difficult patients also had challenging social situations and inadequate support, unrealistic care expectations, were self-destructive, tended to split care-team messages, and had unclear diagnoses. Theme 3: Difficult families: Shared many characteristics of difficult patients including being distrustful, demanding, manipulative, threatening, or angry. Difficult families were barriers to care, disagreed with the treatment plan and each other, did not act in the patient's best interest, suggested inappropriate treatment, or had unrealistic expectations.
STRATEGIES: Approaches to dealing with difficult patients or families included building trust, being calm, and having a consistent message. Communication approaches included naming the emotion, empathetic listening, identifying patient priorities and barriers, and partnering.
CONCLUSIONS: Difficult patients induced emotional responses, dysphoria, and self-doubt among providers. Underlying personality disorders were often mentioned. Difficult patients and families shared many characteristics. Communication and training were highlighted as key strategies.
Author List
Jackson JL, Murphy MG, Fletcher KEAuthors
Kathlyn E. Fletcher MD Professor in the Medicine department at Medical College of WisconsinJeffrey L. Jackson MD Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAttitude of Health Personnel
Female
Focus Groups
Humans
Inpatients
Male
Middle Aged
Physician-Patient Relations
Physicians
Qualitative Research
