Communication skills - Dealing with patients you don't like

Each patient is different, says Dr Tillman Jacobi, so learn to get the best even from difficult consultations

Sooner or later you will come across a patient you do not like, or who does not seem to like you. It is useful to recognise these situations early, reflect on them carefully and find a practical and appropriate solution.

Do not take it personally

It is important not to take this situation personally. It is usually not that you are being inadequate or incompetent, or that the patient is being neurotic, difficult or inappropriate.

Be honest with yourself and think about how many patients you see altogether over the course of a day or a week. As you probably get on with most patients, it should not be too difficult to accept that occasionally the consultation, even if everything was technically ‘correct’, will leave an unpleasant aftertaste.

Patient perception

Furthermore, your initial feeling might be wrong, therefore make sure that the perception that you do not like the patient, or vice versa, is real.

Although perfection in human interaction is not realistic, it is useful to be able to gain a quick and strong rapport with patients from the start — otherwise you increase your stress levels, and are probably more likely to be distracted, make mistakes at some stage, and risk complaints.

Think about the quality of the irritation and the possible reasons for it. Was it a general or particular cause? It could be subtle things such as the tone of voice, smell, certain movements or tics, or the type of medical problem with which the patient presents.

Communication problems

You could be experiencing language barriers or other problems with communication — a patient who talks non-stop for example, or who does not give you enough information.  

If you find yourself becoming irritated during a consultation, the first thing to do is relax and stop trying too hard. Sometimes, it could be best to be honest with the patient and say so. If they cannot accept that you are human, or if they start to become patronising and question your competence, then you need to be honest about your feelings.

Even if you feel that your self-confidence could suffer by doing this, you will be showing real strength and maturity at this point.

If the consultation makes you feel frustrated, desperate, nervous or even angry, try to step back and visualise the situation. Do not forget that some patients become very anxious or stressed when going to the GP.

Accept difference

Seek to accept patients as they are, regardless of status, class, colour, religion or habits. Rather than being judgmental, try to accept a dysfunctional consultation and watch what happens next time. Do not forget that you do an exceptional job adjusting to new people every 10 minutes up to 30 times on a day. It is not something most people could cope with.

Gather information

If you hear that your colleagues have noticed that there is a problem with a patient, then try to gather more information — was there anything obvious that you could or should have done to improve a difficult situation? You could, for example, suggest that the patient sees another doctor.

Feedback

One of the signs that a patient likes you is that they come back to you. Hopefully, the reception staff would pick up on any negative reactions and feed them back to you or your trainer.

If you had any difficult experiences with patients, consider keeping a log of the details.

During a difficult consultation you should always adjust your manner according to the patient.

Opportunity for improvement

Take each difficult interaction as an opportunity to go through them with yourself or with your trainer, other practice members, course organisers or appraisers as a tool to improve your practice. And learn to forgive yourself for not being perfect.

- Dr Jacobi is a salaried GP in York

Learning points

  • How to deal with a patient you do not like
  • Recognise early in the consultation if you think that you are developing a dislike for the patient or vice versa.
  • Think about what is causing the irritation and whether it is a communication problem.
  • If the consultation makes you feel frustrated, desperate, nervous or even angry, try to step back and visualise the situation
  • If you have any doubtful experiences, consider keeping a log of the details of this patient
  • Discuss each difficult case with your trainer, colleagues, or other practice member
  • Learn to forgive yourself for not being perfect

Resources

www.gp-sho.co.uk

www.rcgp.org.uk

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