There are patients who are angry, disrespectful, and rude; basically difficult patients who demand specific drugs or tests, even when they’re not indicated; and patients who growl at everyone, act suggestively to the nurses, or ask you to submit a fraudulent bill so the insurer will cover the cost of treatment.
Add in medications or diseases that can cause confusion, drowsiness or agitation, and it is a whole new ball game of trying to give the best care, professionalism, and empathy. You can run into all reactions including defensiveness, anger, fear, demandingness, hysteria and a whole list of other things. And not just patients, their families too you need to work with and to be around.
But there are useful strategies in handling the unrelenting, frustrated, unpleasant or uncooperative patients. Certain evidence-based practices, however, should be systematically incorporated through patient-care coordination to optimize positive outcomes:
Establish Patient-Centered Goals And Care Priorities
There are several contextual factors in triggering difficult patients. Patient-care coordination must also include processes to periodically reassess difficult patient priorities.
Medical billing and coding staff should develop a mutually acceptable communication process with patients, as well as primary clinicians, and appropriate family members. CMS strongly recommends that patient-care coordinators be embedded within practices; share electronic clinical data through an electronic health record, and follow written protocols implemented by mid-level practitioners. Neglecting patient preferences for communication risks additional care fragmentation.
Manage Communication Between Specialty And Primary Care Providers
Transparent and effective communication processes will reassure patients who are at particular risk for receiving conflicting instructions and information from different clinicians.
Reassess their priorities frequently. Failure to discontinue medications, failure to reassess priorities, and persistent attention to inappropriate disease-specific quality metrics increase the risk of adverse outcomes. Support self-management by focusing on the overall care needs of the patient—regardless of the type and number of chronic conditions. The proposed medical standards as per CMA for patient care coordination include assistance in self-managing at least 1 chronic condition.
Linking Patients With Community Resources And Services
Be alert to changes in mood and emotional well-being of such patients. Difficult patients are at greater risk for depression than individuals without multi-morbidity. Untreated depression risks multiple adverse outcomes and impairs decision making.
Maximize In-Person Delivery Of Care Coordination
Patient-care management programs are the most effective in improving patient outcomes include in-person contact, especially for patients with higher morbidity possibly through better integration of care coordinators into care teams.
Embedding medical coding and care coordinators in practices and as part of the medical home or other team-based care, models increases the potential for face-to-face contact and relationship building.
Integrated, continuous, patient care is a foundational principle of any family medicine. This new benefit is a step in creating payment reform that can support such high-quality primary care especially for “difficult patients”.
Although; coordination of care is one of the fundamental tenets of primary care, this principle has been devalued by an overemphasis on disease management. Effective implementation of this should provide an opportunity to truly engage patients and family members in setting and meeting meaningful care goals. Likewise, this benefit may ensure that integrated and informed care teams emphasize holistic and patient-centered chronic disease management. It remains to be seen whether the specific care coordination standards recommended by medical billing companies will be effective in promoting effective patient-care.