Caring for "Difficult" Patients
Abstract
There are patients, and there are patients. The difficult ones can be "demanding," "noncompliant," "whiny," "entitled," or "manipulative." They can be too different from or too similar to the clinician, too seductive, too unclean, too smart, too fat, too thin, or too anxiety-provoking (McCarty and Roberts 1996). These patients require special attention because their care is very complex and because it invites significant ethical pitfalls. Recognizing what makes some patients "difficult," understanding that "being difficult" is a clinical sign that warrants diagnostic interpretation, identifying the special ethical problems arising in the care of the difficult patient, and responding therapeutically are the key elements of ethically sound care for these challenging patients. It is often obvious who is, or is going to become, difficult. The patient who is perceived as "drug seeking," the patient who is notorious for not taking his medications, the patient who engages in frequent self-mutilating behavior, the patient who seems to complain incessantly, the patient who threatens violence toward clinic staff, the patient who demands discharge from the hospital, the patient who is "just a personality disorder," the patient who seems never to get betterthese are the tough cases. Sometimes the difficult patients can be