Monday morning’s “Mastering Challenging Situations and Complicated Cases: The Office Version” symposium featured presentations on dealing with difficult patients and strategies for conflict resolution, as well as understanding body language. The session then shifted to include interactive role play between panelists to simulate different conversations a physician may need to navigate in the office.
Vance Thompson, MD, said that you first need to figure out if you’re dealing with a difficult person, situation, or both. “One of the most important things that I’m comfortable doing is showing love for my fellow person,” he said, adding that this helps with dealing with patients who are feeling fear. We also don’t know exactly what patients are dealing with in their lives that they’re bringing into the examining lane.
Dr. Thompson said to look for signs of fear in patients, and he has worked hard in his practice to set up an atmosphere where it’s an extremely caring environment.
He offered some tips for physicians to handle these situations well. First, remain calm, caring, and professional. Listen and empathize. Put away distraction, have calm eye contact, and open body language, he said.
Dr. Thompson said it’s also important to allow the person to speak without interrupting. This allows their frustrations to come out, he said.
It can also help to restate their points and ask open-ended questions that require more than “yes” or “no” to encourage them to share their information.
Sometimes you do have to set firm boundaries, and it’s important to validate, but don’t argue.
He told attendees that it’s important not to tell patients to “calm down” because this can escalate frustration further. You definitely don’t want to ignore the issues.
Patients remember how you made them feel, how you listened, and if you stood by them during the difficult time. The moment the patient feels I’m on their side, the conflict gets to a better place, Dr. Thompson said.
During the session, Neda Shamie, MD, acted out a conversation dealing with a patient (played by Jonathan Rubenstein, MD) who has significant haloing 6 weeks out from surgery with a multifocal IOL in the first eye. The patient is now not sure if they want to have their second eye done and wants to know what can be done to make things better.
Dr. Rubenstein, acting as the patient, explained that he can see better, see distance, and can function most of the time without glasses. However, he noted the “funny lights” and halos. He pulled out a list to share the things he was experiencing that interfere with his life and make him unsure what to do with the second eye. “I’m getting a lot of glare that I don’t really understand,” he said, adding that he’s almost blinded driving at times by headlights coming toward him, as well as rings around the moon.
Dr. Shamie explained to her patient that, with a multifocal lens, one of the things that’s inherent to this lens is it splits the light to give a full range of vision. The positives of this lens, she explained to her patient, are you’re able to see distance and can see the computer. But she recognized the halos her patient described, as well as oncoming traffic being bothersome. Multifocal lenses can give you these visual aberrations, she said. “The good news is with time, in most patients it dissipates.”
Then she suggested working together with the patient to figure out what to do with the second eye. Dr. Shamie was sure to stress that she was hearing her patient’s concerns. Much the same way, when you get a new pair of glasses, you notice the edge of the frame initially but then it becomes background noise, she said, adding that her hope for her patient is that this issue will dissipate over time as he adapts. “I can assure you that most patients experience this in the first month or so and then it goes away,” she said.
Dr. Shamie further explained the options her patient has in order to move forward. The first option is to delay the second eye surgery and wait it out to see how the patient adapts with the first eye and if he gets used to it.
The second option is to forge ahead with surgery and not use a multifocal lens in the fellow eye. We can go ahead with a standard lens in the fellow eye, she said.
The third option she presented was if the patient really hates the current lens, exchange it.
Editors’ note: Dr. Thompson, Dr. Shamie, and Dr. Rubenstein have no relevant financial disclosures.
