“So, how does this help me?” “Are you sure you know what you’re doing?” “I don’t know about this.” “This hurts too much.” “Aren’t you a little too young to be a _____?”
You’ve had plenty of them. Difficult patients. The ones that turn your purring well-oiled machine of a workday into a coal powered, Ford Model T with square wheels. From difficult personalities, to non compliance, to just plain nasty people, it can be hard to build a good rapport with these patients so you can help them get better. Somehow, some way, we have to make sure they get out of their own way to make it easier for you to help them. As a physical therapist I always joke that I have a minor in psychology from sheer experience. Lets go over some of the epicly annoying and difficulty patient personalities you may encounter, as well as how to deal with them. Keep in mind these can be either male or female, and are only meant to be a fun way of describing some personalities you many encounter.
The Golden Rule
Before we get into the personalities, its important to know some strategies that work with everyone. You need to know what you’re dealing with, and to do that, you need to be an active listener. Active listening shows one major important thing. That you care. Too often a patient is whisked away to a treatment room only after a few short words or questions by an assistant, only to finally speak to their provider who interrupts them within 10 seconds of explaining their issue. Let the patient talk as long as they want. They will give you most information you could gather with questions. As they talk, watch and listen closely, and try to decide which personality you’re dealing with while coming up with your treatment plan.
“Um, really? You want me to do this how many times?” This person adopts the sign of the sceptic when they’ve had poor past experience with a healthcare provider. This person needs amazing, thorough , explanations with specifics on why XYZ is good for them and why they need to do it. Take all the big words out of your textbook and word vomit all over them. The more better. Like that scene from the exorcist. Except medial knowledge, not satan.
This person built a successful business or held a high position for many years, spent a lifetime telling people what to do, and making fist fulls of cash at every turn. They’re not used to taking “orders” from people and , as a PT, I’ve found that the best way to keep these people compliant is to make genuine friends with them. Ditch the professional attitude, because if you don’t, the treatment becomes just another business transaction where they feel like they have to be the dominant one. If you’re just 2 buddies chatting, they will be much more receptive to advice.
There are many derivatives of The Bitch. Keep in mind that’s gender neutral term. The Bitch is generally a shit person, talks down to you and especially to the front office staff. For some reason they believe they’re better than you, and are quick to find flaws in your treatment so they can validate their preconceived opinion of you and healthcare in general. You need to break that wall down as soon as possible. If you can, show results from day 1, even if you have to tell a white lie. For example, “WOW look at how much more range of motion you’ve gained after doing that exercise!” The Bitch also responds best to flattery, so some small talk about their appearance or work ethic can also help.
Missed appointments, doesn’t take their meds, doesn’t do their home exercise program, and more. The Flake is essentially the same as The Sceptic without outright calling you out. The same strategy applies for them. Knowledge drop HARD and they’ll start doing what they’re told.
This person really, REALLY wants to get better. Like yesterday. They’re also a Google scholar and can convince themselves they have ovarian cancer if they have a runny nose. If you can steal their phone and block WebMD you should definitely do that. They’ll assume that any errant symptom you havn’t specifically addressed as a sign their care has gone horribly awry. Reassurance is the best action here. Calm and collected treatments without too much information. Tell them everything they’re experiencing is normal and you see loads of people with the same problems, even if you don’t. In addition, The Hypochondriac needs to be reigned in. They will literally take every bit of advice and run with it, if you ask them to do something once a day, they’ll do it five. Ice for 15 min, they do 60. Again, reassurance and education. Nothing they feel is abdominal, and you’ve seen it all before.
This person is usually harmless, a older male or female that makes some innocent inappropriate comments here and there, and also requests you as their provider. Most often a simple request to cut those comments out will suffice, but if a patient persists and makes you genuinely uncomfortable, it’s best to speak with your manager and request that you no longer see that patient.
They’ve seen it all, and they’ve lived for way longer than they even expected. Bones and organs are turning to dust and there isn’t a speck of cartilage left in most of their joints. The Ancient doesn’t necessarily have to be a nasty person, and in fact they are typically pleasant, but they’ve surrendered to the fact that modern medicine can’t make them any younger. And they’re right. The Ancient really just needs a friend, and a straight forward , no bullshit assessment of their condition. They want you to say, “yeah there’s no curing XYZ, but we can do a few things that might make you feel better, or help you do ____.” Tempering YOUR own expectations for their care is more important here. Someone who is 90+ and wheelchair bound for several years will most likely never walk again. But if you can do some things to keep them comfortable, or otherwise perform a daily task more easily, you’ll be their hero.
The worst of them all. Most often also The CEO, The Know-It-All for some reason believes they are better clinician than you, without a degree. Or experience. Or knowledge. Or self awareness for that matter. They’re the person that knows best in every aspect of their lives. The Know-It-All needs to be shown, not told, what will help them. For example, “If you don’t do XYZ, you’ll get worse”, *insert know-it-all comment here*. You just need to accept the fact that they will get worse if they don’t heed your advice. They have to see and experience that for themselves. When possible, you need to have a significant “I told you so” moment to get them to fully understand they are not the expert. It’s the sad truth, but the only way.
So those are some difficult personalities I’ve encountered so far and how I usually handle them. Using some of the above strategies, you’ll hopefully be able to help them. Do you have any other personalities , I haven’t included? Let us know in the comments!