MEDiscuss • Clinical Medicine - General • How to Handle Uncooperative Patients

This morning, I was asked to examine a patient in the surgical ward. As I approached him, I noticed that he was very uncooperative and did not even respond to me properly at first. As I kept on, he was a bit irritable and asked me to get lost!

To top it, I was later chewed by the registrar for not examining the patient! How do I handle such patients?

There are two dimensions to this problem. One is patient and the other, student.

The patient is suffering from a disease, may be depressed, hopeless, in grief, afraid or have other strong emotions. We just tend to dump all these into one single word - "uncooperative".

Students prefer a patient who is neat, cooperative and has an interesting disease. When they encounter a different patient, they get disappointed and put off. This indicates a failure of understanding of illness and its adaptive responses.

How do we "handle" such patients?

Approach the patient with empathy and try to understand the reason for the uncooperative or hostile behaviour. You can also confront the emotion directly - "Are you angry with me?", "Do you suspect that I am going to cause more pain?", "Do you think I am going to waste your time?" etc. Generally people soften when confronted like this.

If your previous contact with the patient is responsible for the behaviour, apologize and offer support.

Sometimes the reason for the behaviour can be what the patient has experienced with the treating clinician or other students. Try to find the reason and offer to help solve it within your limits.

Importantly, if any patient's behaviour is hostile bordering on violence, you must report to the senior clinicians immediately and avoid aproaching the patient alone.