The "Difficult" Inpatient, a Qualitative Study of Physician Perspectives

Area of Science:

• Medical Education
• Patient Care
• Healthcare Management

Background:

• Previous research on difficult inpatients primarily focused on psychiatric populations.
• Limited understanding exists regarding the specific characteristics of difficult inpatients within general medicine settings.

Purpose of the Study:

• To investigate the defining characteristics of difficult inpatients in a general medicine setting.
• To identify provider experiences and effective management strategies for these patients.

Main Methods:

• Qualitative study employing focus groups and semi-structured interviews with 28 medicine inpatient providers.
• Thematic content analysis of transcribed interviews using MAXQDA software.

Main Results:

• Difficult inpatients are time-consuming, evoke negative emotions (frustration, dysphoria) in providers.
• Patient characteristics include uncooperative behavior, personality disorders, challenging social situations, and unrealistic expectations.
• Difficult families share patient traits, act as barriers to care, and disagree with treatment plans.

Conclusions:

• Difficult inpatients and their families present shared challenges, often inducing emotional distress in healthcare providers.
• Underlying personality disorders are frequently observed in difficult patients.
• Enhanced communication, empathetic listening, and consistent messaging are crucial strategies for managing difficult patient and family dynamics.