Podcast: A Therapeutic Primer for Primary Care Physicians: The Value of Talk - Part 2: The Difficult Patient

At one time or another, every primary care physician will probably see a patient who is a hypochondriac, a chronic complainer, or a substance abuser. Rather than seeing these patients as difficult and avoiding them as much as possible, the physician can reframe the problem as an opportunity for growth and development. Dr Lieberman suggests that keeping the sessions brief but allowing more frequent visits and addressing medical and psychosocial concerns will make your relationship with your patient more positive. Managing hypochondriacal patients, chronic complainers, and substance abusers will be much easier after listening to Dr Lieberman’s suggestions.

Rules for clinicians
1. Breathe.
2. Smile.
3. Remember that the patient is the one with the problem but acknowledge his or her suffering.
4. Try to be nice.
5. Set realistic expectations and set limits.

Hypochondriacal patients
• Schedule regular visits at predetermined intervals.
• Follow BATHE protocol at every visit.
• Don’t let length of visits exceed your tolerance.

Chronic complainers
• Re-education.
• Stress reduction.
• Convince patients of importance of changing behavior. Change is possible. There’s a payoff for trying.
• Breakdown assignments to modest, feasible tasks.
• Reinforce patient’s efforts.

Substance abusers
The acronym CAGE is useful in forming the questions that will help make a diagnosis of substance abuse.
C Have you ever felt that you needed to cut down?
A Are you annoyed by criticism?
G Have you ever had guilt feelings?
E Have you ever needed an eye-opener?

A Therapeutic Primer for Primary Care Physicians: Part 2: The Difficult Patient

 In part 1 of this podcast series, Dr Lieberman discusses tools that can help you recognize and manage mental health disorders within the time constraints of a primary care office visit.