1 / 22

Dysfunctional Consultations

Dysfunctional Consultations. c/o Dr Ramesh Mehay www.bradfordvts.co.uk. Aims. Recognition of different types of difficult patients Whose problem is it? Why are they so important? How to deal with them. Objectives. SESSION 1 Define a dysfunctional consultation?

hazel
Download Presentation

Dysfunctional Consultations

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Dysfunctional Consultations c/o Dr Ramesh Mehay www.bradfordvts.co.uk

  2. Aims • Recognition of different types of difficult patients • Whose problem is it? • Why are they so important? • How to deal with them

  3. Objectives SESSION 1 • Define a dysfunctional consultation? • Define a difficult patient? • Is it a problem in the patient or the doctor? Coffee SESSION 2 • Groves Classification of difficult patients • Specific Methods of dealing with them

  4. SESSION 1 LET’S THINK ABOUT THEM Who are they and How do I recognise them?

  5. What is a dysfunctional consultation? “An exhausting consultation between a doctor and a patient which often triggers off some powerful negative emotions either in the doctor dealing with them, in the patient or both!

  6. Brainstorming Session Working in pairs make a list of difficult types of patients you have encountered.

  7. Brainstorming Session Now working in groups of four share your lists and aggregate them into common groups

  8. How common are they? EVERY GP has them and so will you!

  9. What’s all the Fuss? • Doctor Reasons Stress, fear, anger, low morale, helplessness • Patient Reasons unnecessary Ix & Rx • Society Reasons Expensive!

  10. Whose Problem is it Anyway? • The patient • The doctor • The Dr – Pt relationship

  11. Is it the Patient – list of features • Female > male • Age > 40 • Single, divorced or widowed (isolation) • personal (marital, family) problems • Co-existing depression

  12. Is it the doctor? • Different people have different personalities and characteristics Mathers et al (1996) Sheffield Survey of GP’s 65% variance amongst GP’s in their selection of heart sink patients You can please SOME people ALL of the time BUT You can never please ALL of the people ALL of the time

  13. Is it the Doctor? • Insecure Doctors • Competitive Doctors • Over caring Doctors • Hard line Angry Doctors • Doctors of Perfection • Normal Doctors – Yes You!!!!

  14. Is it the Dr-Pt Relationship? • Leading to • Failing to understand patients ICE • Failing to appreciate affect on patients life • Failing to appreciate patients coping mechanism Flipchart 1. Unidirectional Consultations patient doctor 2. Patient behaviour that annoys the doctor – Christie & Hofmaster (1986) “Pull Yourself Together” report (2000), Mental Health Foundation) 3. Certain Medical Illnessses - Christie & Hofmaster (1986)

  15. How Can You Spot Them? Working in pairs – think how you might recognise them in practice? Think in these broad areas: • Patient characteristics • Patient beliefs • The types and nature of consultations

  16. SESSION 2 The Meaty Bit! How do I deal with them?

  17. Groves In 1951 he described hateful patients! His four categories are just as applicable now! • The dependant clinger • The entitled demander • The manipulative help rejector • The self destructive denier • The malodorous minger (oops!...sorry, that’s one of mine!)

  18. Why GP’s Don’t Like Them • Negative emotions ranging from hopelessness to anger • Diagnostic difficulties and the ‘devil of uncertainty’ • Time (often long multiple appointments) • Cost (emotional cost to you and the financial cost to the Practice and the NHS)

  19. Why is it important to have a management plan? • Working in pairs list the reasons • Then in groups of four think about the ways in which you can manage these four types of heartsinks; dependant clinger, entitled demander, manipulative help rejector and the self destructive denier • Now form into 4 groups each taking one of the different classes, formulate and then present your plan

  20. Why Is it Important to Have a Management Strategy For them? • Prevent chronic sick role • Reduce doctor dependency • Avoid doctor shopping • Maintain the doctor-patient relationship some how • To make the doctor feel comfortable in dealing with them (exterminate negative emotions) • To avoid missing a true illness

  21. RULES FOR ALL OF THEM 1 • Recognise own feelings • Build rapport • Encourage more patient responsibility • Firm structured consistent approach • Keep in control • Frequent attenders – boundaries/limits, hierarchical problem list, share the workload, delayed response • “Whose problem is it?” • House keep yourself

  22. Managing them (other solutions) • Boundaries & Limits • Share the workload • Delayed Response • Avoid difficult situations

More Related