Managing Encounters with Overly Needy Patients

Needy patients are part of every medical practice and they can quickly earn a difficult patient label. The need for reassurance from one’s physician is normal. However, patients with a disproportionate need for reassurance can contribute to physician burnout. Particularly in a busy practice with tightly scheduled appointments, very needy patients can become overwhelming.¹ Appointments can end with both patient and physician feeling unsatisfied and irritated.

One place to start in resolving potentiality of burnout with an overly needy patient is to revise your character assessment of the patient. The patient may have underlying behavioral health issues that drive their need for excessive reassurance. Although you may never be able to satisfy the patient’s emotional needs, you can set the patient on a path to better behavioral health, improve reassurance skills,² establish appropriate patient expectations,³ set boundaries on your availability outside of scheduled appointments, and better manage appointment time. Establishing more control during encounters with these challenging patients can reduce the stress and frustration that feed physician burnout.

Patient Expectations

It is important to discover where the patient’s need for reassurance is coming from. Once you understand why the patient has unrealistic expectations of your time and attention, you may be able to help them prioritize expectations in a way that fits the realities of your practice.

• Learn about your patient’s experiences with other physicians. They will most likely report what they liked and disliked, which will give you an idea of what they expect.
• Discover how the patient experiences their symptoms and whether they have preconceived notions of how your treatment will affect those symptoms.
• Discover the patient’s outcome priorities, e.g., returning to work, driving a car, gardening, running, etc. Address the realities of the patient’s expectations.

Patient Organization

Overly needy patients may have trouble describing what is wrong. Providing them with organizational tools can benefit everyone involved.

• Suggest they keep a journal of symptoms, keep self-monitoring diaries, or engage a coach in healthy self-care (rest, nutrition, exercise, stress management tactics).
• Schedule regular appointments (e.g., every couple of weeks) to take place whether the patient is suffering from symptoms or not. This can reinforce healthy behaviors and highlight periods of feeling well. Appointment frequency can be reduced over time.
• Provide patients with a form to help them organize and present their symptoms and concerns.

Appointment Time Management

Creating a structure for the patient’s appointment can use the limited time available to its greatest advantage.

• Ask the patient to arrive with a list of issues to be addressed during the appointment.
  • If the patient lists a variety of symptoms and complaints, negotiate a reasonable number of issues to address in the timeframe of that day’s appointment
  • Ask the patient to prioritize the issues and schedule additional appointments for unaddressed issues.
  • Keep the attention focused on the agreed upon medical complaints.
• At the beginning of an appointment, inform the patient of the appointment length and end the appointment at the designated time.
• Summarize what on the list of issues has been addressed.
  • Formulate a plan with the patient to manage or prevent health concerns discussed.
  • Agree on which issues to discuss in future appointments.
  • Document the plans to the extent necessary to check patient compliance and follow through with objectives.

Boundary Setting

It is important to confirm that the patient understands how to present their concerns in a healthy manner that can be appropriately managed within the constraints of your practice. If the patient starts crossing the line into disproportionate neediness, remind them of your policies. For example, boundary policies could include your protocols for responding to patients experiencing non-emergencies who call the office or present outside of scheduled visits.

Empathy and Composure

Even when patients’ need for reassurances become irritating, it is important to let them know that you care about their health, that their symptoms are valid, and that you are willing to work toward a long-term resolution of their symptoms.

• Acknowledge the patient’s complaints and fears.
• Don’t attempt to satisfy the patient’s emotional needs. Consider whether the patient needs to be referred for counseling or psychiatric treatment.
• Find a way to communicate the difference between quality and quantity of attention from a physician.
• Make use of relaxation strategies such as deep breaths before seeing a challenging patient.

Effective Reassurance Resources

• “‘Doctor, Please Tell Me It’s Nothing Serious’: An Exploration of Patients’ Worrying and Reassuring Cognitions Using Stimulated Recall Interviews.” (BMC Family Practice)
• “‘No Need To Worry’: An Exploration of General Practitioners’ Reassuring Strategies.” (BMC Family Practice)
• “Managing Somatization Disorder” (AMA Journal of Ethics)

References

1. Isabel N. Schuermeyer, et al. “Patients with Challenging Behaviors: Communication Strategies.” Cleveland Clinic Journal of Medicine, vol. 84 no. 7, 535-542.

2. Esther Giroldi, et al. “‘No Need to Worry’: An Exploration of General Practitioners’ Reassuring Strategies.” BMC Family Practice, volume 15, Article number: 133 (2014).

3. Susan Keane Baker. “Entitled Patients: 6 Ways to Respond.” Western Pennsylvania Healthcare News, 6/21/2018.