Clement J Zablocki VAMC, Milwaukee, WI, USA.
Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
J Gen Intern Med. 2024 Aug;39(10):1858-1869. doi: 10.1007/s11606-024-08802-x. Epub 2024 May 20.
Previous studies exploring difficult inpatients have mostly focused on psychiatric inpatients.
To explore the characteristics of difficult medicine inpatients.
Qualitative study using focus groups and semi-structured interviews. Transcripts were recorded, transcribed, and coded (MAXQDA) using thematic content analysis.
Medicine inpatient providers at a tertiary care facility.
Our sample consisted of 28 providers (6 hospitalists, 10 medicine attendings, 6 medicine residents, and 6 interns). Theme 1: Provider experience: Difficult inpatients were time-consuming and evoked emotional responses including frustration and dysphoria. Theme 2: Patient characteristics: Included having personality disorders or mental health issues, being uncooperative, manipulative, angry, demanding, threatening, or distrustful. Difficult patients also had challenging social situations and inadequate support, unrealistic care expectations, were self-destructive, tended to split care-team messages, and had unclear diagnoses. Theme 3: Difficult families: Shared many characteristics of difficult patients including being distrustful, demanding, manipulative, threatening, or angry. Difficult families were barriers to care, disagreed with the treatment plan and each other, did not act in the patient's best interest, suggested inappropriate treatment, or had unrealistic expectations.
Approaches to dealing with difficult patients or families included building trust, being calm, and having a consistent message. Communication approaches included naming the emotion, empathetic listening, identifying patient priorities and barriers, and partnering.
Difficult patients induced emotional responses, dysphoria, and self-doubt among providers. Underlying personality disorders were often mentioned. Difficult patients and families shared many characteristics. Communication and training were highlighted as key strategies.
之前探索困难住院患者的研究大多集中在精神科住院患者上。
探讨内科困难住院患者的特征。
使用焦点小组和半结构化访谈进行定性研究。使用主题内容分析对记录、转录和编码的（MAXQDA）记录进行分析。
三级保健机构的内科住院患者提供者。
我们的样本由 28 名提供者组成（6 名医院医生、10 名内科主治医生、6 名内科住院医生和 6 名实习医生）。主题 1：提供者的经验：困难的住院患者耗时且引起了沮丧和烦躁等情绪反应。主题 2：患者特征：包括有人格障碍或心理健康问题、不合作、操纵、愤怒、要求苛刻、威胁或不信任。困难患者还存在具有挑战性的社会情况和支持不足、不切实际的护理期望、自我毁灭、倾向于分裂护理团队的信息、以及诊断不明确的情况。主题 3：困难的家庭：与困难患者有许多共同特征，包括不信任、要求苛刻、操纵、威胁或愤怒。困难的家庭是护理的障碍，他们不同意治疗计划和彼此的意见，不以患者的最佳利益行事，提出不适当的治疗建议，或有不切实际的期望。
处理困难患者或家庭的方法包括建立信任、保持冷静和保持一致的信息。沟通方法包括命名情绪、同理心倾听、确定患者的优先事项和障碍以及合作。
困难的患者会引起提供者的情绪反应、烦躁和自我怀疑。经常提到潜在的人格障碍。困难的患者和家庭有许多共同的特征。沟通和培训被强调为关键策略。
