Dear John,
Thanks for your thoughtful and respectful comments. You raise some great issues.
You asked, "Have these now become personality disorders?" In fact yes, many of these patients do have personality disorders. I have often had a difficult patient that was driving me crazy until I realized, "Oh, right, she's borderline. Of course! Now her behavior makes more sense."
To look at it another way difficult patients are all spiritually sick. These are people who are not at peace, not happy. The patient who yells at my staff about whether to provide his SSN is usually deeply fearful of the world. These are people who have serious character defects. I have a few myself and have been really obnoxious a time or two (or three).
I find it helpful to frame the problem this way: problem patients are sick (physically, mentally or spiritually). They deserve my compassion, just as nice/compliant patients who are sick. The two year-old with the ear infection, screaming at me, kicking, spitting, trying to bite me as I look in his ears is a great metaphor for all problem patients.
We all get angry at difficult patients. The question is how do we respond to that anger. Frank, at the beginning of this thread, sounds like was able to handle a difficult situation without reacting in anger. Bravo! That's the first step, to avoid reacting out of anger.
But when I'm in these situations, even if I don't react with overt hostility, I will often feel my blood boiling inside. If I take some time to think about the problem patient and the incident, to try to see how they might be suffering, to have compassion for them, to remember that God's in charge, I'm not in control of everyone and everything. It helps sometimes just to vent--perhaps here in a thread like this.
The danger, of course, is to let the anger aroused by the difficult patient eat me up inside, to take it out on myself, eat a dozen donuts or drink a couple of six-packs, or to take it out on others, the next patient, my staff, or my wife.
And no, I don't have this all figured out. Wish I did! It's a lot easier to write about it from the comfort of an armchair while sipping a cup of coffee that to actually do it. I would welcome any thoughts you or others have about how to deal with the difficult patient. No doubt my comeuppance for this post will be a bushelful of difficult patients at my office today. :-)
With best wishes,
John
