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01/20/2018 - 11:05pm
China has turned the northwestern region of Xinjiang into a vast experiment in domestic surveillance. WSJ investigated what life is like in a place where one’s every move can be monitored with cutting-edge technology.
01/20/2018 - 6:39pm

One cannot ignore the potential for conflictive behavior as a potential in medical patient-physician relationships (and indeed associated with other individuals in the medical system interacting with patients and patients interacting with them.) This behavior can be disruptive to attain important professional relationships and effective diagnosis and treatment. 

The following is a brief analysis of the dynamics associated with such behavior and hopefully toward resolution as researched and written by a first year medical student.  The obvious goal, hopefully, is resolution of potential conflicts to promote a therapeutically effective doctor-patient relationship.  My visitors' views on this issue are welcome.  ...Maurice.

                   DIFFICULT PATIENT VS DIFFICULT DOCTOR                                                                                                      Surabhi Reddy                                   First Year Medical Student
A doctor’s worst nightmare? A patient that is impatient, inattentive, rude, and demanding. A patient’s worst nightmare? A doctor that is impatient, inattentive, rude, and demanding. A so-called “difficult patient” or “difficult doctor” represent two sides of the same coin, with similar behavioral and communicative factors causing conflict. Occasionally, the difficult relationship may culminate in amessy outburst – as recently seen in a violent altercation between a Gainesville doctor and patient.1  The duality of the patient-physician relationship allows us to examine (from both perspectives) what underlying actions and issues initiate the conflict – and eventually focus on mediation and resolution. Addressing the “difficult” nature of these parties is a vital first step towards creating positive patient-physician relationships and health outcomes.
You may hear the phrase “difficult patient” offhandedly thrown around in a physician’s lounge – a blanket term like “problem child” or “one of those” that draws universal understanding but little clarity on the specifics of the interaction. Physicians characterize 15-20% of all patients as “difficult.”2,3 Such encounters point to a strong association between the “difficult” characterization and patient mental disorder – namely, depression, panic disorder, and anxiety.2,3 Doctors note these patients are either 1) not interested in a medical opinion whatsoever, or 2) have repetitive, non-specific complaints.However, it was also noted that difficult patients are hard to describe and characterize as a group.4 Mental health does not preclude a difficult interaction. In a series of interviews, physicians described “difficult” as conversational issues such as patients being “violent, demanding, aggressive, rude and [seeking] secondary gain.”5 Physicians describe their primary motivations as the desire to solve medical problems and help others – and anything that stymies this process sadly draws the label “difficult.”
The onus is not completely on the patient, however. One study points out that the difficulty may stem from the doctor’s work style, belief system, and/or cultural barriers.5 The more experienced a family medicine physician is, the less likely he/she is to characterize a patient as “difficult” – suggesting that there is a burden on the doctor to develop the interpersonal skills to handle the interaction. Collectively, physicians that report high frustration with patients are those that are younger, work longer hours, and have symptoms of depression, anxiety, and stress.6 While physicians often characterize patients as difficult, patients are less likely to describe their physician as so. In most studies, patients are evaluated for their “satisfaction,” which includes many aspects of their medical care, including perceived expectations, the underlying medical condition, and other members of the healthcare team. This may also reflect the power dynamic between patient and physician. Patient complaints may be dismissed, once again, as the patient being “difficult” - leaving the physician immune to criticism.
The difficult patient-physician relationship involves both behavioral (mental disorders, stress) and communicative (rude and aggressive language) factors from both parties. Ultimately, cooperative relationships stem from respect, empathy, and patience. As one physician stated in his interview, “First of all, what I have learned with the years is being empathetic toward [patients].” Taking the time to understand another’s perspective can go a long way in making the difficult into easy.5


1.       Bever, Lindsey. (2017). A doctor shouted at a sick mother to 'get the hell out.' Now he's under criminal investigation. Washington Post. 2.       Hahn, S. R., Kroenke, K., Spitzer, R. L., Brody, D., Williams, J. B., Linzer, M., & Verloin deGruy, F. (1996). The difficult patient. Journal of general internal medicine, 11(1), 1-8. 3.       Jackson, J. L., & Kroenke, K. (1999). Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Archives of Internal Medicine, 159(10), 1069-1075. 4.       Koekkoek, B., van Meijel, B., & Hutschemaekers, G. (2006). " Difficult patients" in mental health care: a review. Psychiatric Services, 57(6), 795-802.5.       Steinmetz, D., & Tabenkin, H. (2001). The ‘difficult patient' as perceived by family physicians. Family practice, 18(5), 495-500.
6.       Krebs, E. E., Garrett, J. M., & Konrad, T. R. (2006). The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data. BMC health services research, 6(1), 128. 

 GRAPHIC: From Google Images.

01/20/2018 - 4:55pm

The Southern California Bioethics Committee Consortium (SCBCC) is a group of health care professionals who meet regularly to discuss the medical, legal, and ethical dimensions of “doing” bioethics in Southern California.

01/19/2018 - 11:31pm

by Lori Bruce, MA

News broke this week that the U.S. Department of Health and Human Services is creating a new “Conscience and Religious Freedom Division” (CRFD) in the Office for Civil Rights. This new division will support healthcare workers who refuse to treat patients based on moral or religious convictions: “OCR enforces laws and regulations that protect the free exercise of religion and prohibit discrimination in HHS-funded or conducted programs and activities.” U.S. law defines the exercise of religion as “any exercise of religion, whether or not compelled by, or central to, a system of religious belief.”

Patients belonging to LGBTQ populations as well as patients seeking reproductive health services (abortions, birth control, and vasectomies) or assisted suicide (where legal) now face uncertain care: “OCR enforces laws and regulations that protect conscience and prohibit coercion on such issues as abortion and assisted suicide (among others) in HHS-funded or conducted programs and activities.”   From a cursory review of their new website, the limits of CRFD are unclear. …

01/20/2018 - 11:05pm
Découvrez 5 mesures de l’Europe sur la question des technologies émergentes et du transhumanisme dans un lieu de choix, le parlement européen de Bruxelles.
01/19/2018 - 5:33pm

by Craig Klugman, Ph.D.

The Good Doctor (Season 1; Episode 12): Life and Death

Continuing a storyline from last week, this episode centered around the conjoined twins who had to be quickly separated. One twin awakes and is doing well except that her heart failure has not improved. If anything, she is getting worse and may not make it through the night. Her sister is unconscious and suspected to be in a nonsentient state. Their mother decides to remove the ventilator from the unconscious sister so that her heart can be transplanted into the surviving one.…

01/19/2018 - 1:43pm

The U.S. Department of Health and Human Services (HHS) has formed a new Conscience and Religious Freedom Division in the HHS Office for Civil Rights (OCR).

01/19/2018 - 10:47am

Advocates are tracking new developments in neonatal research and technology—and transforming one of America's most contentious debates. With comments from our Debra Mathews

01/19/2018 - 10:03am

Christopher Robertson and Kelly McBride Folkers write, "Despite the policy’s broad support, it has yet to help a single patient in Arizona obtain an experimental drug that they couldn’t have gotten before. Thirty-seven other states have also passed right to try bills, but likewise have seen little real impact for patients."