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