Size Up Difficult Patients and Manage Accordingly.

BEAVER CREEK, COLO. -- Physicians will be better able to deal with difficult patients when they recognize the feelings that such patients provoke in themselves, Dr. Peter T. Watson said at a perinatal conference sponsored by the University of California, Irvine.

Difficult patients generally fit one of four profiles, and the physician who recognizes which profile a patient fits can better adopt the right strategy for handling that patient, said Dr. Watson of Oregon Health Sciences University Portland.

"It is all about self-awareness," said Dr. Watson, an obstetrician. "If you pay attention to how you are feeling, it may be a clue to how they are feeling."

Most difficult patients have an agenda. They want good care, and they feel powerless within the system or they fear a loss of a relationship with the doctor. Paradoxically, their behavior often alienates the doctor. This can lead to physician mistakes and other adverse events.

Physicians who do not like a patient are liable to stop returning phone calls and may sometimes even act in a hostile manner, intentionally saying something to hurt or offend the patient, Dr. Watson said.

There are, however, better ways of handling these patients. The following are Dr. Watson's recommendations for recognizing and managing the different types of difficult patients:

* The dependent, clinging patient.