Changing How We Think about Difficult Patients: A Guide for Physicians and Healthcare Professionals

By Joan Naidorf, DO

Physicians enter their professions with the highest of hopes and ideals for compassionate and efficient patient care. Along the way, however, recurring problems arise in their interactions with some patients that lead physicians to label them as “difficult.” Some studies indicate that physicians identify 15% or more of their patients as “difficult.” The negative feelings that physicians have toward these patients may lead to frustration, cynicism. and burnout.

Changing How We Think about Difficult Patients uses a multi-tiered approach to bring awareness to the difficult patient conundrum, then introduces simple, actionable tools that every physician, nurse, and caregiver can use to change their mindset about the patients who challenge them. Positive thoughts lead to more positive feelings and more effective treatments and results for patients. They also lead to more satisfaction and decreased feelings of burnout in healthcare professionals.

How does this book give you an advantage?

Caring for difficult patients poses a tremendous challenge for physicians, nurses, and clinical practitioners. It may contribute significantly to feelings of burnout, including feelings of exhaustion, cynicism, and lost sense of purpose. In response, Dr. Naidorf offers a pragmatic approach to accepting patients the way they are, then provides strategies for providers to find more happiness and satisfaction in their interactions with even the most challenging patients and families.

Here are just some of the topics the author discusses in detail:

• What Makes a ”Good” Patient?
• Four Core Ethical Principles of the Clinician-Patient Relationship
• The Four Models of the Physician-Patient Relationship
• What Challenges Anybody with Illness or Injury?
• How “Good” Patients Handle the Challenges of Illness and Injury
• Six Common Reactions to Illness and Hospitalization
• On “Taking Care of the Hateful Patient”
• Standards for Medical Ethics
• De-escalation Strategies
• Cultural, Structural, and Language Issues
• Types of Patients Who Tend to Challenge Us
• The Think-Feel-Act Cycle
• Recognizing Our Preconceived Thoughts
• Three Common Thought Distortions About Patients
• Asking Useful Questions
• Getting Out of the Victim Mentality
• Guiding our Thoughts Through a Common Scenario
• Show Compassion, Feel Compassion

If you’re a healthcare provider or caregiver, Changing How We Think about Difficult Patients will give you the benefit of understanding your most challenging patients, and a roadmap to positively changing your mindset and actions to better deliver care and compassion for all. 

Table of Contents

Chapter 1. We Can’t Stand Some of Our Patients

• Negative Think
• The Hidden Curriculum
• Choosing our Thoughts with Think-Feel-Act
• Choosing our Thoughts with Intention

Chapter 2. What Makes a ”Good” Patient?

• The Virtual Instruction Guide
• Four Core Ethical Principles of the Clinician-Patient Relationship
• The Four Models of the Physician-Patient Relationship

Chapter 3. What Challenges Anybody with Illness or Injury?       

• Seven Fears Associated with Illness
• How “Good” Patients Handle the Challenges of Illness and Injury

Chapter 4. How Do Sick and Injured People Feel and Act?

• Six Common Reactions to Illness and Hospitalization

Chapter 5. On “Taking Care of the Hateful Patient”

• The Dependent Clinger
• The Entitled Demander
• The Manipulative Help Rejector
• The Self-Destructive Denier

 Chapter 6. Responding to Dr. Groves: An Evolving Understanding     

• Standards for Medical Ethics
• The Romanell Report
• De-escalation Strategies
• Responses in the Medical Literature
• Cultural, Structural, and Language Issues
• The Divine Spark

Chapter 7.  Our Least Favorite Patients

Chapter 8. How to Manage Our Thoughts

• The Think-Feel-Act Cycle
• Recognizing Our Preconceived Thoughts
• Actions That Move Us Toward Better Outcomes
• Awareness of Negative Thoughts

Chapter 9.  Three Common Thought Distortions  About Patients

• Arbitrary Inference
• All-or-Nothing Thinking
• Mirroring Emotions

Chapter 10. What We Think: Two Common Thought Distortions

• Resisting Reality
• Adopting a Victim Mentality  

Chapter 11: Working Against Ourselves

• The Need to Seek Approval
• Personalization
• Perfectionism

Chapter 12. How We React

• Thoughts and Emotions
• Inactions and Negative Reactions

Chapter 13. Turning It Around

• Asking Useful Questions
• Finding What Has Gone Right
• Deciding How You Want to Feel
• You Can Handle This

Chapter 14. Getting Out of Our Own Way

• Accepting Reality
• This is the Part Where …
• Getting Out of the Victim Mentality
• Choosing Thoughts with Intention

Chapter 15. How It Works

• Guiding our Thoughts Through a Common Scenario
• Decide How You Want to Feel

Chapter 16. Why Does It Matter?

• Retrain Your Brain
• Show Compassion, Feel Compassion 

Chapter 17. No More Difficult Patients      

• A Dose of Reality
• Learning the Skills
• When You Make a Mistake
• Show Compassion for Yourself

About Joan Naidorf, DO

Dr. Joan Naidorf is a board-certified emergency physician trained at the Philadelphia College of Osteopathic Medicine and Einstein Medical Center Philadelphia. After growing up in Highland Park, NJ, she obtained her undergraduate degree at the University of Virginia. She practiced for nearly 30 years in the busy emergency departments of Inova Alexandria Hospital and Fort Belvoir Community Hospital in Virginia.

As an author and speaker, she has been sharing important ideas with students, residents, and practicing physicians through various online and direct engagements. She was recently appointed to the editorial advisory board of The DO magazine.

Her proudest accomplishment has been raising three compassionate and intelligent children alongside Toby, her devoted husband. Toby supplies many stories of the patients who challenge him from his busy gastroenterology practice. In her spare time, Dr. Naidorf enjoys reading, traveling, playing tennis, and walking with Dolly, the miniature poodle.