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Managing difficult personalities in the medical office
- 1. Managing difficult personalities in the medical office
- 2. Personality Disorders Poor coping skills Interpersonal relationships Unusual thinking Impulse control Large range of emotions
- 3. Why Talk About it? Can be distressing to those interacting NOT diagnosing Address traits
- 4. Traits that show poor coping and the skills you have to help
- 5. Difficulty assessing appropriate boundaries Empathetic and compassionate but not their friend
- 6. Difficulty assessing situation Take a minute to help problem solve Make a note in the chart so next time you can remind pt of the solution you came up with
- 7. Only my caregiver can help Help pt make a list of supports that you both can turn to
- 8. Annoying people get sick too Try not to fob everything off as a PD Keep the focus on the presenting complaint
- 9. Self centred Channel patient's skills into dealing with illness Set clear limit
- 10. Fear Be empathetic Avoid direct challenge to fear Provide clear explanations
- 11. Deceit, anger, impulsive Investigate motives and concerns Clear, non punitive communication Set clear limits
- 12. Dramatic, attention seeking Avoid excessive familiarity Focus on objective issues
- 13. Fear of abandonment Set short, regular visits Any minor issues should be deferred to these visits Set realistic boundaries on availability
- 14. Distress Validate their experience Use soothing words Reassuring actions
- 15. Anger Tolerate angry outbursts but set limits Validate the patient's experience but always be safe
- 16. Hate you, love her Be consistent in how you interact w pts Don't take it out on each other
- 17. Communicating about these traits Use objective language - avoid subjective Include quotes Pt owns their chart, be kind
- 18. How the pt feels Confusing, exhausting, painful All or nothing Defective Self centred
- 19. How the pt feels Over reading situations Obsessing with identity Extreme emotions
- 20. How we react to these pts
- 21. Intense feelings about the patient Positive or negative Difficulties with interpersonal relationships
- 22. Apprehension Apprehension Waiting for something to happen Learned response after having many crisis situations High emotional intensity
- 24. Inconsistency of care Depending on interaction may want to avoid or please the pt Can cause conflict bw staff members
Editor's Notes
- Poor coping skills, not well socially developed Impact is on interpersonal relationships - more upsetting to others than themselves as a rule Unusual thinking - difficulty making connections Impulse control often low Large range of emotions Quickly change from angry to ecstatic Often have associated mental health problems Can be very distressing to the caregiver team
- Diagnosis of a personality do takes many focused visits and is based on years of evidence
- Think about the training we went through this spring You have the skills
- Asking about the personal things you'd ask about with any pt, no more Can be distressing to pt if they mis interpret boundaries
- Many of these folks think everything is life and death Focus in the skills these pts have already If those who answer the phones want a stamp for this to guide a conversation and make it easy to look up later, let me know
- Can show dependence on the caregiver Need to recognize help outside the clinic as well Help make a list BUT need pt to feel supported by the team as well. They need to know it is safe to call in. Can be a tricky balance. Thank the pt for calling
- Do the same triage job you would in anyone Focus on the presenting complaint Keep returning to complaint when pt tries to diverge Emotional support but focus away from emotions Tricky huh?
- Pts who forget that other people exist Often somewhat aware, can you think of another solution to this problem that doesn't require our team?
- Can be irrational or rational
- Don't say lie, I prefer the word fib "Why did you think it was important to fib to me?" Make sure pt knows we need the respect of our time and process and that we'll respect the pt in return
- Sometimes get focus on their self image, try not to engage beyond normal niceties Avoid excessive familiarity Focus on objective issues
- Calls daily, needs to talk to doc now without giving a reason Can take a while to train patient to follow these new rules
- May seem ridiculous to you, life and death to pt
- Remember pt has a hard time understanding their environment and social cues
- Black and white thinking Need to be kind to each other
- Don't put anything in EMR you wouldn't say to the pt's face
- "It's confusing, exhausting and so painful that you wish you had a physical injury that would validate having that much pain. It's like living in a world of all or nothing in utmost extremes. Anything and everything becomes about you. It's like knowing that you're severely defective in some way but extremely defective in some way, but extremely self centred at the same time. "
- "You are a master at reading and researching what everyone is thinking about you and then reacting with extreme emotions that seem to come out of nowhere, whilst convincing yourself that this is all warranted and the "right" thing to do. Add to that the overwhelming feelings of emptiness, obsessing with identity and self image and then harming yourself in endless ways in punishment for all of the above."
- Our reactions to these patients are usually the first clue that the patient may have traits of personality disorders.
- Normal reaction, don't take it out on the pt
- Share it with pt, "I worry..." Use your own social supports