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1

LLEWELLYN, FAY. "Difficult Patient." Nursing 29, no. 1 (January 1999): 48–50. http://dx.doi.org/10.1097/00152193-199901000-00017.

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&NA;. "Difficult Patient." Nursing 21, no. 8 (August 1991): 51–53. http://dx.doi.org/10.1097/00152193-199108000-00016.

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3

SCHAFFELD, MARY MARGARET. "Difficult Patient." Nursing 21, no. 9 (September 1991): 60–62. http://dx.doi.org/10.1097/00152193-199109000-00018.

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4

MENGEL, TAMMI ERVING. "DIFFICULT PATIENT." NURSING 22, no. 1 (January 1992): 50–52. http://dx.doi.org/10.1097/00152193-199201000-00015.

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5

SCHMITT, DIANA. "DIFFICULT PATIENT." Nursing 19, no. 7 (July 1989): 43–46. http://dx.doi.org/10.1097/00152193-198907000-00017.

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CARLEY, LORI. "DIFFICULT PATIENT." Nursing 19, no. 8 (August 1989): 56. http://dx.doi.org/10.1097/00152193-198908000-00019.

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7

&NA;. "DIFFICULT PATIENT." Nursing 19, no. 12 (December 1989): 54–56. http://dx.doi.org/10.1097/00152193-198912000-00026.

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8

SCHMITT, DIANA M. "DIFFICULT PATIENT." Nursing 19, no. 3 (March 1989): 55–56. http://dx.doi.org/10.1097/00152193-198903000-00022.

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9

RENZ, MARION CASEY. "Difficult Patient." Nursing 23, no. 10 (October 1993): 58–60. http://dx.doi.org/10.1097/00152193-199310000-00021.

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10

RANDOLPH, KATHLEEN. "Difficult Patient." Nursing 21, no. 3 (March 1991): 56–57. http://dx.doi.org/10.1097/00152193-199103000-00021.

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11

Lecic-Tosevski, Dusica, Mirjana Divac-Jovanovic, and Dragan Svrakic. "Difficult treatment of difficult patient." Personality and Mental Health 4, no. 3 (July 15, 2010): 233–36. http://dx.doi.org/10.1002/pmh.134.

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12

Agazarian, Yvonne. "The difficult patient, the difficult group." Group 11, no. 4 (December 1987): 205–16. http://dx.doi.org/10.1007/bf01459385.

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13

Simon, Jeremy R., James Dwyer, and Lewis R. Goldfrank. "THE DIFFICULT PATIENT." Emergency Medicine Clinics of North America 17, no. 2 (May 1999): 353–70. http://dx.doi.org/10.1016/s0733-8627(05)70064-x.

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14

Kahn, James S. "A Difficult Patient." Annals of Internal Medicine 168, no. 11 (June 5, 2018): 830–31. http://dx.doi.org/10.7326/m18-0691.

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15

SALLADAY, SUSAN ANTHONY. "A Difficult Patient?" Journal of Christian Nursing 23, no. 2 (2006): 31. http://dx.doi.org/10.1097/00005217-200605000-00010.

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16

Rahav, Miriam. "A Difficult Patient." American Journal of Hospice and Palliative Medicine® 31, no. 3 (April 14, 2014): 345–46. http://dx.doi.org/10.1177/1049909113480261.

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17

Thompson, Carrie A. "The Difficult Patient." Journal of Clinical Oncology 26, no. 24 (August 20, 2008): 4035–36. http://dx.doi.org/10.1200/jco.2008.16.0408.

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18

Ricke, Amy K., Men-Jean Lee, and Joanna E. Chambers. "The Difficult Patient." Obstetrical & Gynecological Survey 67, no. 8 (August 2012): 495–502. http://dx.doi.org/10.1097/ogx.0b013e318267f1db.

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19

Hinshelwood, R. D. "The difficult patient." British Journal of Psychiatry 174, no. 3 (March 1999): 187–90. http://dx.doi.org/10.1192/bjp.174.3.187.

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20

Samuelson, Darlene. "The Difficult Patient." Journal for Nurses in Staff Development (JNSD) 15, no. 1 (January 1999): 38. http://dx.doi.org/10.1097/00124645-199901000-00010.

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21

MACINTOSH, R. R., and F. B. PRATT. "The difficult patient." Pediatric Anesthesia 6, no. 4 (July 1996): 316. http://dx.doi.org/10.1111/j.1460-9592.1996.tb00456.x.

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22

Guthrie, Elspeth, and Francis Creed. "The difficult patient." European Journal of Gastroenterology & Hepatology 6, no. 6 (June 1994): 489–94. http://dx.doi.org/10.1097/00042737-199406000-00007.

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23

Van Vliet, Dennis. "The “difficult” patient." Hearing Journal 55, no. 1 (January 2002): 66. http://dx.doi.org/10.1097/01.hj.0000292484.80684.ca.

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24

Bui, Anh. "The difficult patient." Current Surgery 61, no. 2 (March 2004): 178–79. http://dx.doi.org/10.1016/j.cursur.2003.11.001.

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25

Hahn, Steven R., Kurt Kroenke, Robert L. Spitzer, David Brody, Janet B. W. Williams, Mark Linzer, and Frank Verloin deGruy. "The difficult patient." Journal of General Internal Medicine 11, no. 1 (January 1996): 1–8. http://dx.doi.org/10.1007/bf02603477.

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26

Semonin-Holleran, Reneé. "The Difficult Patient." Journal of Emergency Nursing 33, no. 4 (August 2007): 309–10. http://dx.doi.org/10.1016/j.jen.2007.06.017.

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27

SHALITA, A. "The difficult acne patient." Journal of the European Academy of Dermatology and Venereology 11 (September 1998): S29. http://dx.doi.org/10.1016/s0926-9959(98)94640-2.

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28

Druss, Richard G. "My most difficult patient." Lancet 360, no. 9347 (November 2002): 1796. http://dx.doi.org/10.1016/s0140-6736(02)11678-3.

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29

Kerr, Nancy. "Managing the Difficult Patient." Emergency Medicine News 27, no. 4 (April 2005): 59. http://dx.doi.org/10.1097/00132981-200504000-00010.

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30

&NA;. "Documenting difficult patient encounters." Nursing 30, no. 1 (January 2000): 69. http://dx.doi.org/10.1097/00152193-200030010-00028.

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31

Breen, K. J., and P. B. Greenberg. "Difficult physician-patient encounters." Internal Medicine Journal 40, no. 10 (July 19, 2010): 682–88. http://dx.doi.org/10.1111/j.1445-5994.2010.02311.x.

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32

Kupfer, Yizhak, and Sidney Tessler. "Weaning the Difficult Patient." Chest 119, no. 1 (January 2001): 7–9. http://dx.doi.org/10.1378/chest.119.1.7.

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33

Davis, Carol M. "The “difficult” elderly patient." Topics in Geriatric Rehabilitation 3, no. 3 (April 1988): 74–84. http://dx.doi.org/10.1097/00013614-198804000-00011.

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34

Brushwood, David B. "Dismissing the ‘difficult’ patient." Pharmacy Today 26, no. 12 (December 2020): 38. http://dx.doi.org/10.1016/j.ptdy.2020.11.016.

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35

Welds, Kathryn. "Managing the Difficult Patient." Hospital Practice 30, no. 6 (June 15, 1995): 24E—24I. http://dx.doi.org/10.1080/21548331.1995.11443207.

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36

Hartman, D. "Regarding the ‘difficult patient’." British Journal of Psychiatry 175, no. 2 (August 1999): 192. http://dx.doi.org/10.1192/bjp.175.2.192a.

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37

Selvaraj, Vidhya. "Treating the ‘Difficult’ Patient." Psychiatric News 45, no. 7 (April 2, 2010): 11–23. http://dx.doi.org/10.1176/pn.45.7.psychnews_45_7_023.

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38

Slop, Mr. "Re: The difficult patient." Bulletin of the Royal College of Surgeons of England 102, no. 5 (July 2020): 175. http://dx.doi.org/10.1308/rcsbull.2020.141.

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39

Henderson, M. J. "A difficult psychiatric patient." Postgraduate Medical Journal 76, no. 899 (September 1, 2000): 585–86. http://dx.doi.org/10.1136/pmj.76.899.585.

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40

Essary, Alison C., and Susan L. Symington. "How to make the “difficult” patient encounter less difficult." Journal of the American Academy of Physician Assistants 18, no. 5 (May 2005): 49–54. http://dx.doi.org/10.1097/01720610-200505000-00007.

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41

Janosevic, Danielle, Aileen X. Wang, and Jay B. Wish. "Difficult Patient Behavior in Dialysis Facilities." Blood Purification 47, no. 1-3 (December 6, 2018): 254–58. http://dx.doi.org/10.1159/000494592.

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Difficult behavior exhibited by dialysis patients is a spectrum that includes nonadherence, verbal or physical abuse, and threatening acts. Such behaviors may lead to harmful consequences to the patient, other patients, the facility, and staff and can culminate in involuntary discharge. It is important to recognize that these “difficult behaviors” may be due to underlying psychosocial or medical issues, which places an onus on care providers to explore further. According to the Conditions for Coverage (CfC) for dialysis facilities, it falls upon the medical director to coordinate and oversee policies for patient satisfaction, patient safety and rights, involuntary discharges, and adverse events and outcomes. Thus, medical directors are liable for their own actions, and their staff for which they have oversight, for harm or perceived harm to patients in response to difficult behaviors. Guidelines to deal with specific patient behavior scenarios have been published by the Decreasing Dialysis Patient Conflict National Task Force of the Forum of end-stage renal disease (ESRD) Networks. The common denominator for these difficult scenarios is impaired communication, and the majority of patient concerns involve issues with staff, policies, treatments, and diet. Involuntary discharge of a patient should always be viewed as a last resort, and there is a structured process described in the CfC that requires the involvement of the respective ESRD Network and the facility medical director. As physicians, we are bound by ethical and growing legal obligations to act in an appropriate, ethical, and fair manner to patients who are considered to be “difficult.”
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42

Ristic, Jelena. "Managing the difficult diabetic patient." Veterinary Nursing Journal 26, no. 1 (January 2011): 15–17. http://dx.doi.org/10.1111/j.2045-0648.2010.00004.x.

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43

Ambrosino, Nicolino, and Luciano Gabbrielli. "The difficult-to-wean patient." Expert Review of Respiratory Medicine 4, no. 5 (October 2010): 685–92. http://dx.doi.org/10.1586/ers.10.58.

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44

Camanho, Gilberto Luis. "The difficult doctor–patient relationship." Revista Brasileira de Ortopedia (English Edition) 48, no. 6 (November 2013): 469–70. http://dx.doi.org/10.1016/j.rboe.2013.12.001.

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45

Roberts, Seth. "Mindfulness and the Difficult Patient." Journal of Pain and Symptom Management 39, no. 2 (February 2010): 376–77. http://dx.doi.org/10.1016/j.jpainsymman.2009.11.295.

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46

Arena, Francis P. "Dealing with the difficult patient." Community Oncology 2, no. 1 (January 2005): 63–64. http://dx.doi.org/10.1016/s1548-5315(11)70851-8.

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47

BUNSTER, JANE. "The Patient Difficult to Reach." Journal of Analytical Psychology 38, no. 1 (January 1993): 37–44. http://dx.doi.org/10.1111/j.1465-5922.1993.00037.x.

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48

Shiffman, Melvin A. "Management of the Difficult Patient." American Journal of Cosmetic Surgery 9, no. 4 (December 1992): 331–32. http://dx.doi.org/10.1177/074880689200900406.

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49

Mayer, Michelle L. "On Being A ‘Difficult’ Patient." Health Affairs 27, no. 5 (September 2008): 1416–21. http://dx.doi.org/10.1377/hlthaff.27.5.1416.

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50

Horwitz, Leonard. "The Difficult Patient in Group." International Journal of Group Psychotherapy 42, no. 1 (January 1992): 164–67. http://dx.doi.org/10.1080/00207284.1992.11732589.

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