Between 15 and 60% of patients are considered “difficult” by their treating physicians. Patient psychiatric pathology is the conventional explanation for why patients are deemed “difficult.” But the prevalence of the problem suggests the possibility of a less pathological cause. I argue that the phenomenon can be better explained as a response to problematic interactions related to health care delivery. If there are grounds to reconceive the “difficult” patient as reacting to the perception of ill treatment, then there is an ethical obligation to address this perception of harm. Resolution of such conflicts currently lies with the provider and patient. But the ethical stakes place these conflicts into the province of the ethics consult service. As the resource for addressing ethical dilemmas, there is a moral mandate to offer assistance in the resolution of these ethically charged conflicts that is no less pressing than the more familiar terrain of clinical ethics consultation.
Open Peer Commentaries.
- "Difficult" Patients or Difficult Relationships
- Reconceiving the Relationship and Supporting Physician Responsibility
- Reframing Nonepileptic Seizure Patients' Care: Shifting the Blame
- Addressing "Difficult Patient" Dilemmas: Possible Alternatives to the Mediation Model
- Understanding Communication to Repair Difficult Patient-Doctor Relationships from Within
- Why Some Conflicts Involving "Difficult Patients" Should Remain Outside the Province of the Ethics Consultation Service
- Difficult Patients, Difficult Doctors: Can Consultants Interrupt the "Blame Game"
- Clinical Ethics and Patient Satisfaction: The Practical Significance of Distinguishing Ethics and Morals