Partnering with Patients, Families and your Hospital to Manage and Decrease Challenging Patient Encounters-Presentation

Video Transcription

Video Summary

The webinar from SHM’s Practice Management series focused on how to approach and manage challenging patient encounters in hospital medicine. Speakers Dr. Adia Ross and Dr. Shelley Homer emphasized that difficult encounters are usually not just about a “difficult patient,” but about complex interactions among patients, families, clinicians, and the health system.<br /><br />They discussed common contributors such as communication breakdowns, mismatched expectations, psychiatric illness, delirium, substance use, cognitive impairment, and lack of social support. The presenters introduced the idea of “treatment-interfering behavior,” which includes actions by patients, families, or clinicians that disrupt care. They also explored how illness can trigger fear, helplessness, shame, and loss of control in patients, while clinicians may respond with avoidance, burnout, boundary issues, or therapeutic abandonment.<br /><br />Practical solutions were offered at multiple levels: recognizing emotional reactions, setting clear limits, using team communication effectively, creating behavioral plans, and responding consistently to unsafe behavior. System-level strategies included psychiatric consultation, behavioral rounding nurses, behavioral emergency response teams, workplace violence committees, administrative discharge processes, and policies for disruptive patients and families.<br /><br />The Q&A addressed delirium, large families, VIP patients, terminal illness, and racial or cultural mistrust, stressing compassion, consistency, and curiosity.

Keywords

hospital medicine

challenging patient encounters

treatment-interfering behavior

communication breakdowns

psychiatric consultation

delirium

behavioral plans

workplace violence

patient-family interactions