Managing difficult personalities in the
medical office
Personality Disorders
Poor coping skills
Interpersonal relationships
Unusual thinking
Impulse control
Large range of emotions
Why Talk About it?
Can be distressing to those interacting
NOT diagnosing
Address traits
Traits that show poor coping and the skills you
have to help
Difficulty assessing appropriate boundaries
Empathetic and compassionate but not their friend
Difficulty assessing situation
Take a minute to help problem solve
Make a note in the chart so next time you can remind pt of the solution you came up with
Only my caregiver can help
Help pt make a list of supports that you both can turn to
Annoying people get sick too
Try not to fob everything off as a PD
Keep the focus on the presenting complaint
Self centred
Channel patient's skills into dealing with illness
Set clear limit
Fear
Be empathetic
Avoid direct challenge to fear
Provide clear explanations
Deceit, anger, impulsive
Investigate motives and concerns
Clear, non punitive communication
Set clear limits
Dramatic, attention seeking
Avoid excessive familiarity
Focus on objective issues
Fear of abandonment
Set short, regular visits
Any minor issues should be deferred to these visits
Set realistic boundaries on availability
Distress
Validate their experience
Use soothing words
Reassuring actions
Anger
Tolerate angry outbursts but set limits
Validate the patient's experience but always be safe
Hate you, love her
Be consistent in how you interact w pts
Don't take it out on each other
Communicating about these traits
Use objective language - avoid subjective
Include quotes
Pt owns their chart, be kind
How the pt feels
Confusing, exhausting, painful
All or nothing
Defective
Self centred
How the pt feels
Over reading situations
Obsessing with identity
Extreme emotions
How we react to these pts
Intense feelings about the patient
Positive or negative
Difficulties with interpersonal relationships
Apprehension
Apprehension
Waiting for something to happen
Learned response after having many crisis situations
High emotional intensity
Anxiety
Unpredictable
Manipulative
Stressful behaviours
Inconsistency of care
Depending on interaction may want to avoid or please the pt
Can cause conflict bw staff members