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On Being A ‘Difficult’ Patient
PREFACE: Rarely do difficult patients get to weigh in on why they are "difficult"—and rarely do doctors get to explain to difficult patients why it’s difficult to care for them. In the first of these essays, patient Michelle Mayer, a research professor in North Carolina with a chronic autoimmune system disease, tells why she eventually became a difficult patient, and how it helped her get the doctoring she needs. Next, Tony Miksanek, a doctor from a small town in Illinois, details what happens during visits with some of his difficult patients, all of whom, in different ways, demand things that go against his best professional judgment. Mayer and Miksanek might not reach agreement on all of the issues involved, but there’s one thing on which they concur: policies that prescribe brief, pre measured office visits don’t allow enough time for patients and doctors to get to know one another, discuss medical issues, and reach considered decisions. Until patients and doctors have the time—literally—to work together, the process often will be difficult for all involved and results might be painful as well.
A COLLEAGUE RECENTLY introduced me to a young physician, noting that her research interest was difficult patients. "Really," I responded. "I’m a difficult patient, and it’s served me well." I assumed that she considered being a difficult patient a good thing, but her pained expression suggested otherwise. We shared an awkward moment before parting, and I walked away considering the plight of the "difficult" patient.
In the clinical world, the term difficult is applied to a variety of patients: the noncompliant; the rude, abusive, and manipulative; the malingering; the mentally ill; the skeptical. In my case, I too frequently challenged
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