Changing the narrative on ‘difficult’ patients: Emergency physician to host webinar

As an emergency physician, Joan Naidorf, DO, quickly became accustomed to interacting with patients and caregivers from all walks of life. She describes the emergency department as “a chaotic place where very sick children and adults require a logical and compassionate approach to diagnosis and care.”

Dr. Naidorf found she was running into challenging interactions with a couple patients or family members on every shift. As a shorthand, they were called “difficult” patients.

“No matter how well I did with most of my patients, two or three left me feeling frustrated, defeated or angry,” said Dr. Naidorf. “I set about researching the issue to see if I could do a better job with the types of people and problems that were presenting.”

Now, Dr. Naidorf is sharing the results of her research in a webinar presented by the American Osteopathic Information Association on Aug. 28 at 7 p.m. ET. Dr. Naidorf’s talk will center on changing how we think about difficult patients. It will include a fast-moving discussion that addresses both sides of the doctor-patient interaction. Dr. Naidorf plans to discuss the challenges that patients have while navigating the system and some of their typical behaviors during illness or injury. She will also review medical literature that discusses four common types of challenging patients.

The webinar will last for one hour, and costs $60 for AOA members and $85 for non-members. It has been approved for 1.0 AOA Category 1-A credit. It will be available to view until Dec. 31.

“Understanding the challenging patient types helps physicians understand why they feel so cynical sometimes,” says Dr. Naidorf. “I discuss some of the thought distortions that health care professionals fall into. Changing how we think starts with awareness of the sorts of thoughts we are having now and how some of those are not serving us or our patients well.”

The webinar will introduce some ideas from cognitive behavioral therapy regarding how our thoughts about patients determine the feelings we have about them. Our feelings can determine the actions we take or do not take, and our actions determine what results we get. For instance, if we think we already know that the sleepiness in a patient is due to his alcohol intake, we might miss the traumatic brain injury he also sustained while drinking.

“After I retired from the clinical practice of medicine, I revisited the lessons that I learned with a few new ideas that I published in the form of a book, “Changing How We Think About Difficult Patients: A Guide for Physicians and Health Care Professionals,” said Dr. Naidorf. “The message of my talk and the book is that there are no ‘difficult’ patients, only challenging interactions with real humans. Physicians can change how they think about ‘challenging’ people to find more curiosity and empathy.”

Dr. Naidorf describes how many physicians can fall into a routine of questioning reality—why their patients presented how they did, and how things could have happened differently. The webinar wraps up with some of the devices and questions she recommends to mold our thoughts and actions with more intention. It’s a little bit of course-correction and self-help for practice-weary physicians. For trainees entering their clinical years, the messages can be a total game-changer.

“There is a better way of approaching the challenging cases and it does not rely on the patients or their families changing at all,” said Dr. Naidorf. “It involves changing the only things that we can control—how we think and how we act.”

Register for the webinar through the AOA’s Online Learning Center here.