No doctor welcomes the frequent visits of a rude, complaining patient who makes unreasonable demands and doesn’t follow medical advice. Our anonymous GP wonders if such ‘difficult’ patients could be helped more effectively.
As GPs we use the term ‘heartsink’ to describe a certain group of patients. These are patients who pull the life out of you. They are often manipulative and time-consuming, and attend frequently. When you see their name on your clinic list you sigh, and sometimes have a physical reaction: a ‘heartsink’. They are people we try to help but feel we get nowhere with.
Not all frequent attenders are heartsinks. Most, of course, have genuine medical or even social problems, which I am pleased to help them with. Sometimes I find that a complicated patient can be overwhelming and gives me a feeling of, “Crumbs, how am expected to deal with all this?”
But if I admit to them and to myself that their medical care is not straightforward, and make sure that the situation is safe today, I can then bring them back for a longer appointment. This means they become someone I can help rather than feel overwhelmed by, and can get a real sense of achievement and satisfaction from.
Unreasonable demands that play on my mind
The people who really make my heart sink are patients who manipulate me, are persistently unreasonable in their demands of me or the wider NHS, or who are rude and complain frequently. These patients play on my mind and I continue to think about them a long time after the consultation has finished.
I worry that I could improve my clinical or communication skills in order to manage them better and I worry they will complain about me or the practice. I also worry that, as their GP, I am not managing precious NHS resources appropriately.
I can easily think of patients whom I have seen this week and whom I will worry about for the next few weeks. I have spent far too much time doing that already!
One patient sees me approximately monthly, and asks for phone consultations in between. She does have some minor health problems, but not severe. For example, she will book an urgent appointment for her child to be diagnosed with a verruca, although she knows in advance what the problem is.
She continually asks for second opinions or further investigations. I explain again and again how I don’t think she needs them. I have explained patiently why the NHS cannot fund certain treatments and investigations. I try to be the gatekeeper to the more expensive secondary care services, but it’s really hard when someone is asking all the time. If I do get it wrong and don’t refer, it will not end well for me.
If I do get it wrong and don’t refer, it will not end well for me.
Most of the time I feel worn down by her and generally do what she wants. Then I feel terrible afterwards, as I am wasting NHS resources, as well as failing to show appropriate assertiveness and finding strategies to manage this lady’s behaviour. I haven’t identified why she behaves like this: I am sure she is very anxious, but there is also something manipulative about her behaviour, which is difficult to handle.
Walking on eggshells
Another ‘heartsink’ patient I worry about is a man with multiple health problems who does not accept medical advice. He complains frequently about health professionals in long, ranting letters, doesn’t take his medication correctly and won’t accept advice to seek further help when he needs to.
Each consultation with him takes 30 minutes rather than ten and after he leaves I have never achieved what I wanted to. I don’t manage to find a way to draw the consultations to a close in a polite and safe way. To add to the difficulty, he also has an assertive son who phones intermittently, in a rather aggressive way, to complain about his father’s care.
I can understand why some patients don’t follow medical advice, but if you mix that with a patient and family who complain frequently, it isn’t a good combination. I feel as if I’m treading on eggshells, and document furiously all of my consultations in order to protect myself in case things go wrong.
Being a GP is not only about knowing lots of medicine and managing common conditions, it is also about managing people, some of whom are difficult characters. As an NHS GP you can’t choose your patients!
About the author
The Secret GP
Our anonymous doctor shares what it’s really like behind the scenes in the surgery.