What Do Doctors And Nurses Mean When They Refer To A Patient As "Difficult"?

First, I’ll tell you what an “easy” patient is. An “easy” patient is one who comes to the ER for help, and then accepts it. They might question some parts of the treatment (“do I really need to have an IV?”); they might refuse certain comfort measures (“I’m not nauseated, so I’d rather not have any nausea medication”, but they don’t issue orders to the doctor (“No, I don’t want a flu swab or a strep test. Just give me some antibiotics and discharge me”).



“Easy” patients don’t treat the nurse like a servant, or harass or insult the staff. They don’t pull out their IVs or sneak food or fluids they’re not supposed to have.

Notice that I didn’t say that unstable patients, or patients who require a lot of rapid interventions, are difficult. Clinically, they can be a challenge, but usually when nurses refer to a patient as “difficult,” they’re referring to a lack of cooperation, not clinical condition.

Some features of “difficult” patients:

1. Patients who come to the ER and expect to be treated immediately, even when there’s a whole roomful of patients ahead of them, and when some of those patients are equally sick, or less stable. (We get that you don’t want to sit in a waiting room full of sick people. We really do. However, we can’t kick other patients out before their treatment is complete, just to make room for you right away.)
   
   
2. Belligerent patients who threaten and insult the staff.
   
   
3. Ambulance patients with family members who make a scene when they can’t go back right away. If we’re not sending you back to the patient’s room immediately on arrival, it’s generally because there’s a crowd in there, trying to get stat lab work, respiratory treatments, Xrays, scans, etc., as quickly as possible. Yes, we know you’re worried about the person. But the quicker we get those tests started, the quicker we can start treatment.
   
   
4. Patients who refuse to follow instructions. If we tell you you can’t get up out of bed, it’s for your own safety, not because we feel like being bossy. If we tell you you can’t have any food or oral fluids, even just a little bit, it’s for a good reason (to prevent aggravating your nausea or abdominal pain, or because we anticipate that you may need emergency surgery or sedation.
   
   
5. Patients who don’t follow up on their treatment, but keep coming back to the ER with the same untreated problem. One recent example: a patient came to the ER with painful urination, and was diagnosed with a urinary tract infection. This person never got around to getting his/her antibiotic prescription filled (“I didn’t think I needed it”), and then showed up two days later in the ER. “My pain is worse!” (NOTE: I do realize that some patients don’t pick up prescriptions because they can’t afford them. I always recommend that they mention this to the doctor. S/he can often prescribe a cheaper medication that works well for their situation, even if it’s less convenient (e.g, an antibiotic that must be taken 4 times a day, instead of once or twice.).

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