Connecting with the Reality of “Difficult” Patients

Portrait of a Patient in Saint-Paul HospitalIt’s a fact. Healthcare professionals are human and so are their patients. So inevitably they will – regardless of their professionalism – encounter friction with some patients. These are patients who wind up being labeled “difficult” and all too often because of that label, receive care that is less than optimal.

Physician Joan Naidorf says that this is a subject that professionals avoid. It feels wrong. But they need to face it and change the way they think about it, she says. Because the issue will be present whether they acknowledge it or not. In fact, it can be more corrosive when professionals don’t acknowledge it.


It’s not uncommon for people living with obesity to be seen as difficult. For  example, Rebecca Puhl, Joerg Luedicke, and Carlos Grilo found that a third of trainees in advanced professional health disciplines report feeling frustration with patients who have obesity, presuming them to be unmotivated to make needed lifestyle changes and thus to be difficult. Nearly three quarters of them did not believe it is professionally rewarding to care for such patients.

You can be sure that these feelings show through when a person with obesity engages with health professionals.

Connecting with Reality

To deal with “difficult” patients, it helps to connect with reality. It is certainly true that some patients are simply hateful. James Groves described this in a classic essay for the New England Journal of Medicine in 1974. More recently, in the Postgraduate Medical Journal, John Launer suggests a constructive framework:

“I prefer to understand dysfunctional communication in terms of interactions that are flexible, rather than personalities that are fixed. That is not to say that patients cannot behave in ways that are challenging, including being angry or rude. Rather, it is to accept that the real challenge is usually how to remedy the situation by the way you respond. This perspective is taken for granted in fields like counselling, mediation, social work, or therapy. In those settings, ‘difficult’ behaviour is recognised as being a common result of adverse experiences or former encounters with authority, and as a consequence of feeling powerless. At root, it signifies suffering and frustration with the failure to relieve it.”

Humans will not cease being difficult. But labeling and dismissing people will always make it worse. Connecting with the reality of our biases and the humanity of people we encounter can make it better.

Click here for Naidorf’s essay and here for Launer’s perspective.

Portrait of a Patient in Saint-Paul Hospital, painting by Vincent van Gogh / WikiArt

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October 16, 2022