Partners in Care:
Dealing With Patients with Challenging Personalities
by John J. Wernert, MD
“ If you attach to the negative behavior of others, it brings you down to their level.”- Guru Singh
You arrive early to the office after a good night’ s rest. While enjoying your morning coffee, you peruse the Tuesday morning schedule after your team huddle. Your stomach churns as you note that your 11:15 patient has already been in twice this month with diffuse somatic complaints and will not accept your advice or reassurance that she is stable. She is on the schedule today insisting she needs higher doses of her medication and feeling“ stressed out.” She also wants to meet with your practice manager to complain about the long waits and the crowded waiting room. It’ s bound to be a grueling day!
Practicing the healing arts can be difficult. Medicine’ s toughest moments often stem from those challenging conversations with demanding patients. It’ s hard not to react emotionally to these arduous interactions. Why are some patients so taxing?
Everyone has a different set of personality traits which forms a unique character structure. One of those unique“ developed styles” is how we interact with other humans and hopefully how we communicate our needs and desires. Interacting with a caregiver is one of the most trying examples of personal communication. Tough patients often present as anxious, demanding, somatic and downright annoying, particularly when presenting with unmeasurable symptoms like chronic pain, anxiety or low mood. These interactions can be quite wearisome and can ruin an otherwise pleasant day if you are not carefully considering the possible underlying reasons for such behavior.
Asking brief questions about the individual’ s home or personal life reveals tumultuous relationships, social wants and unmet needs.
They often don’ t trust their caregivers because they don’ t have trust in others in their lives. Anxiety abounds and is poorly managed. Is this the personality of a person in pain, or something more chronic and insidious like a personality disorder?
Personality is the combination of thoughts, emotions and behaviors that makes everyone unique. It’ s the way you view, understand and relate to the outside world, as well as how you see yourself. Personality forms during childhood, shaped through an interaction of:
• Your genes: Certain personality traits may be passed on to you by your parents through inherited genes. This is also known as temperament.
• Your environment: This involves the surroundings you grew up in, events that occurred and relationships with family members and others. Early life trauma and abuse can cause the most extreme examples of impaired behavior in later life, especially in managing stress and maintaining positive relationships.
Difficult personalities are common, especially in medicine. These individuals are perceived as demanding, resistant and non-compliant. However, these behaviors are modifiable, and change is possible, as opposed to personality disorders, which are a type of mental disorder. Someone with a personality disorder typically has behaviors that are much harder to modify. Personality disorders in general usually stem from a history of childhood chaos, trauma or abuse. Those who suffer from this tend to have family members with personality disorders. These most difficult patients have rigid and unhealthy patterns of
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