Those working on the frontline in primary care may not have been overly surprised by the results of the recent MPS survey, which showed that more than a half of GPs experience challenging interactions with patients on a weekly basis.
Every practice has a small minority of patients who can be unco-operative, difficult, demanding, aggressive, abusive or even violent. They may have unrealistic expectations or be unwilling to take responsibility for their health. But it is not only patients that can make interactions challenging: a doctor who is stressed, tired, or overworked is more likely to interact poorly with a patient; frustration with inadequate resources, time restraints, and a lack of support can all combine to make dealing with challenging patients much harder.
|Key findings from the MPS poll|
It is of course subjective: an interaction that is challenging to one doctor may not be a problem for another, but there is no doubt that these encounters have a negative impact on GPs and their team. They use up valuable time, resources, and emotional energy, and it is in everyone’s interests to try to minimise the frequency with which they occur. So what can practices do to help GPs manage challenging interactions? Here are a few suggestions:
Set realistic expectations for patients
Patients are often well informed about their health as a result of the huge amount of information available to them online. This is beneficial in helping them to make decisions about their care, but may also lead to high expectations which can cause conflict between what the patient wants and what the GP can deliver. Good communication - understanding what the patient wants and why, and clearly explaining what is and is not achievable – is key to addressing this.
Set clear boundaries
There should be a policy in place for managing poor behaviour by patients, with which the whole practice team should be familiar. This will ensure that problems are dealt with consistently and that the staff involved feel supported. Removal of a patient from the practice list is a last resort, but the process should be clear for all staff so that adequate warnings are given and documented.
Courses in communication skills can help GPs to understand the reasons for challenging interactions and learn how to handle them. Training for non-clinical staff is also important as problems may start or disputes may be continued at the front desk. All staff should be aware of the factors that can combine to create a challenging interaction, so that steps can be taken to reduce them.
Try to put adequate time aside for appointments for complex patients, which might require educating both reception staff and patients. Make sure there is clear and accessible patient information about appointment times, duration of appointments, the need to book double appointments for multiple issues, and alternatives to seeing the GP.
Encourage discussions of difficult consultations at practice meetings as an opportunity for GPs to debrief and seek support and input from colleagues. The MPS survey results could be a good prompt for a discussion about how the issue of challenging interactions could be addressed in your practice.