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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

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Published on: February 16, 2011

The approach to the difficult patient.

Elizabeth Loder¹

¹Division of Headache and Pain, Department of Neurology, Brigham and Women’s/Faulkner Hospitals, Harvard Medical School, Boston, MA 02130, USA. eloder@partners.org

Handbook of Clinical Neurology

|September 7, 2010

Summary

Certain patient and physician factors make headache management challenging. Addressing psychiatric issues, shifting to a management rather than cure approach, and using collaborative strategies can improve care for difficult headache patients.

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Area of Science:

Neurology
Psychiatry
Healthcare Management

Background:

Patient and physician characteristics can influence the perception of
difficult
headache patients.

Purpose of the Study:

Identify factors contributing to the perception of difficult headache patients.
Outline strategies for managing challenging headache cases.

Main Methods:

Review of patient factors (psychiatric pathology, unexplained symptoms, substance abuse, refractory headaches).
Analysis of physician factors (age, stress, treatment models).

Main Results:

Patients with psychiatric issues, unexplained symptoms, substance abuse, or refractory headaches are often perceived as difficult.
Younger, stressed physicians not using collaborative models are more likely to find patients difficult.

Conclusions:

Management strategies include addressing psychiatric/substance abuse issues, shifting to a management goal, using treatment agreements, and employing integrated, multimodal approaches.