Blame Dr Google or the ‘era of entitlement’, but the difficult patient is on the rise and they’re costing your practice dearly – and not just financially. GPs with a high number of problem patients – or ‘heart-sinks’ as they’re best known in the profession – are less likely to report feelings of job satisfaction, and more likely to feel burned out. More often, it’s the doctor-patient relationship that needs to be assessed rather than merely the gripes of the patient, and we’re here to help.

Tell-tale symptoms

Studies suggest that most GPs will have around eight ‘heart-sinks’ on their patient list. A problem patient is one who – for whatever reason – impedes the GP’s ability to establish a therapeutic relationship. Someone who refuses to assume the typical patient role, and who may have ideas and beliefs contrary to those of the caregiver. Typical problem patients are men and women over forty, often with marital or other family problems. Sometimes they are isolated in their domestic situation, and may have co-existing depression. New GPs inheriting a patient list can often spot a problem patient a mile off: bulging medical file and appointment / referral / investigation list as long as their arm. A study in the 1950s separated problem patients into the four categories below, and it seems not much has changed…

• The dependent clinger
• The entitled demander
• The manipulative help-rejecter and
• The self-destructive denier

Relationship surgery

Interestingly, doctors polled in the seventies painted a portrait of the ‘ideal patient’ as one who was trusting, non-complaining, compliant and undemanding. Patients who were perceived as not being seriously ill but complaining, emotional, and uncooperative were often discharged from care early or referred to psychiatric care. Could it be that some of these attitudes remain today, and that part of the problem lies in a GP’s perception of their patient?

 Know your team

As a practice manager you will know better than anyone that GPs can often fall into a number of personality brackets – more of that in another post soon – and it’s your responsibility as overseer to manage personality clashes between doctor and patient. Is the problem actually being exacerbated (or created) by the insecurities of a new doctor, or one with too much on her plate at home? Is it a GP who won’t seek second opinions, or one whose tolerance levels need checking? Talk to your GPs about their patient gripes and see whether the problem can be alleviated by their own perceptions.

…And if all else fails, try encouraging them to book with a different GP next time. Perhaps one with a specialism in their area of need.