Richard Dean Smith, MD

Experience dealing with a host of difficult to impossible situations may help others in their encounters with these difficult and distrusting patients. Individuals covered in this case make up only a small per cent of patients and family members, probably less than 5 per cent, but take up 90 per cent of energy in coping with day-to-day conflicts that arise from their behavior.

Most people are reasonable and able to trust most of the time, but those individuals who are outliers, three or four standard deviations off the norm of human behavior, under the stress of illness, require an extraordinary amount of time and energy from an already stressed staff. We must cope with the distrustful, but we seldom talk about these difficult, distrustful and sometimes threatening individuals amongst ourselves; rather we suffer and endure them unnecessarily by ourselves. The problem is timeless as recorded in the world’s literature. Broad categories and a general outline are presented, acknowledging that many exceptions arise. Some exhibit multiple aspects of distrust.

It’s the Law of the Jungle brought to the bedside. Out of the wreckage of human behavior comes valued experience leading to maneuvers and tactics of survival that are appropriate to almost all aspects and settings of human interaction: schools, families, teams, corporations, etc. To those who find my descriptions and experience meliorative to their daily coping with the difficult and distrustful, I say hurrah! For those who don’t, I say good luck, anyway.

Contents:

Preface

Chapter 1 Shock to the System

Introduction
A Shock to the System
The Two Most Difficult, the Bimodal Society
The Socio-Economically Advantaged: The Sick Sybarite Syndrome
The Socio-Economically Disadvantaged, Medicaid
Mom’s List
Sign of the Yellow Tablet

Chapter 2. Complaints

The Complainer
The Complaint
The Angry, Upset Complainer
The Help Rejecting Complainer
The Habitual Complainer
The ‘Why’ Question

Chapter 3. Confrontation.

Street Fight
Intimidation
The Hateful Patient
Virulent Visitor. The Schmoo Enigma
Managed Care Monster
Telephone Terrorist
Bad News

Chapter 4. Big Shots

Angry Relative from Out of Town. The Neglected Parent Constellation
The Big Shot From Out of Town (BSFOT)
The Famous Person Constant
The Machiavelli Principle: Toxic Health Care Professional

Chapter 5. Passive Distrust

The Guilt /​ Shame Duality
Thanks Anyway, Doc
Splitters and Squatters
The Alternative Medicine Parry
The Absolutist

Chapter 6. Futility

“You’re the Doctor.” Bounded Rationality-Informed Consent
Personality Conflict
The Dooney Bourke Boundary
Disgust Leads to Distrust
Pillar to Post: from the borderline and beyond.

Chapter 7. Rehab Milieu

Lucy’s Hair
Cats and Dogs: Homesickness
Crisis at 7 to 10 days: Italian Prozac
Family in Crisis
“She’s a Fighter”
The Vanishing Family

Chapter 8. Physicians and Conflict

Physicians and Conflict
Fear
“My Former Doctor”
“If you want to be my doctor!”
Flattery
“And How Are You, Doctor?”

Chapter 9. Conclusions

The Socially Inept
Ray Charles: “The Snake.”
A Word For It: Rebarbative
Additional Guidelines
Conclusion